Objective: We aimed to assess the fracture risk among contemporary menopausal hormone therapy (MHT) users in Korean. Methods: A nationwide Korean population-based cohort study including all 143,194 women aged 45 years having used systemic MHT during the study period (Jan 2003 and Dec 2006), compared with the Korean female background population. MHT ever-use (all MHT, estrogen-only MHT [E-MHT] and estrogen plus progestin MHT [EP-MHT]) and fracture diagnoses were based on the nationwide Health insurance review & assessment service. For fracture diagnoses, standardised incidence ratios (SIRs) and 95% confidence intervals (CIs) were calculated. Results: The SIR of femur neck fracture was 0.84 (95% CI: 0.73-0.98) following ever MHT, 0.95 (95% CI: 0.69-1.30) for E-MHT and 0.27 (95% CI: 0.14-0.55) for EP-MHT and 0.79 (95% CI: 0.64-0.98) for livial and 0.87 (95% CI: 0.68-1.11) for EP-MHT (except livial). The lowest SIR was found for EP-MHT (including livial) among users aged 55~65 years (SIR Z 0.18, 95% CI: 0.03-1.31). The risk of spine facture was decreased following EP-MHT (SIR Z 0.85, 95% CI: 0.64-1.11). The SIR of total fracture (femur neck, spine, wrist) was 0.83 (95% CI: 0.68-1.00) following EP-MHT. Conclusion: MHT, especially EP-MHT, was associated with a decrease in total fracture risk.