INS and osteoporosis: Furthermore, this clinical trial also observed drug-related side effects, such as breast pain and vaginal bleeding, with greater risk in the CEE + MPA group than in the placebo group.364 In addition to direct effects on osteoporosis, menopausal hormone therapy reduces the risk of T2DM, enhances insulin sensitivity, and improves glycemic control, which may exhibit indirect and long-term benefits to bone health.365