The effect of oral contraceptive different patterns of use on circulating IGF-1 and bone mineral density in healthy premenopausal women (original) (raw)
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BMC Women's Health, 2011
Background: Insulin-like growth factor-1 (IGF-1) is important in normal growth, development, and homeostasis. Current use of oral contraceptives (OC) decreases IGF-1 concentrations; however, the effect of past use, age/timing of use, and type of OC used on IGF-1 levels is unknown. OC are the most commonly used form of birth control worldwide. Both IGF-1 and OC use have been linked to premenopausal breast and colorectal cancers, osteoporosis and cardiovascular disease (CVD). Understanding the effects of different patterns of OC use on IGF-1 levels may offer insight into its influence on disease risk in young women. Methods: In a cross-sectional study of 328 premenopausal women ages 18 to 21 and 31 to 40 we examined the relationship between different patterns of OC use and circulating IGF-1 using adjusted linear regression analysis. Information on OC use was obtained through an interviewer administered questionnaire. Plasma IGF-1 was assessed with enzyme linked immunosorbent assay (ELISA). Results: Among women aged 18 to 21, ever OC use was significantly associated with decreased IGF-1 levels compared to never use (β = -57.2 ng/ml, 95% confidence interval (CI): -88.7, -25.8). Among women aged 31 to 40, past users who first used OC at 25 years of age or older (β = 43.8 ng/ml, 95% CI: 8.8, 78.8), in the last 15 years (β = 35.1 ng/ml, 95% CI: 9.3, 61.0) or after 1995 (β = 46.6 ng/ml, 95% CI: 13.4, 79.8) had significantly higher IGF-1 levels compared to never users. Conclusion: This is the first study to highlight the long term effects of OC use after cessation on IGF-1 levels among premenopausal women, which previously were thought to be transitory. Future studies of past use and IGF-1 levels are required and must consider age/timing of use and type/generation of OC used. Additional studies are needed to confirm the potential mediation of IGF-1 levels in the links between OC use and health outcomes.
Journal of Bone and Mineral Metabolism, 2020
Introduction The purpose of this study was to compare bone mineral density (BMD) and bone turnover markers between combined oral contraceptive (COC) and non-COC users over 12 months. Materials and methods COC users (n = 34, age = 19.2 ± 0.5) and non-COC users (n = 28, age = 19.3 ± 0.6) provided serum at baseline, 6 months, and 12 months. C-terminal telopepetides (CTX) and pro-collagen type 1 N-terminal propeptides (P1NP) were determined using ELISA. BMD was measured at the three time points using dual-energy x-ray absorptiometry (DXA). Results COC users had greater CTX than non-COC users at baseline (18.6 ± 8.2 vs. 13.8 ± 5.3 ng/mL, P = 0.021) and 6 months (20.4 ± 10.3 vs. 14.2 ± 8.5 ng/mL, P = 0.018). Controlling for lean mass, groups were similar in BMD. Over 12 months, non-COC users maintained BMD at the spine, while the COC users declined 2.2% in lateral spine BMD (0.773 ± 0.014 to 0.756 ± 0.014 g/cm 2 , P = 0.03) and 0.7% in anterior-posterior spine BMD (1.005 ± 0.015 to 0.998 ± 0.015 g/ cm 2 , P = 0.069). Non-COC users increased in BMD of the whole body over 12 months (P < 0.001) while COC users had no change. Women who began COCs within 4 years after menarche had lower BMD at the hip and whole body. Women taking very low dose COCs (20 mcg ethinyl estradiol, EE) significantly declined in CTX, P1NP, and lateral spine BMD in comparison to participants using low dose COCs (30/35 mcg EE). Conclusion College-aged women who did not use COCs increased BMD of the whole body, while COC users had elevated bone turnover, declines in spinal BMD, and lack of bone acquisition of the whole body over 12 months. Young females who initiate COC use early after menarche may experience skeletal detriments.
Decreased bone turnover in oral contraceptive users
Bone, 1995
The objective of this study was to determine the effect of oral contraceptive pills on bone turnover. The design consisted of a cross-sectional analysis of a prospective cohort. There were 52 women taking oral contraceptives and 156 nonuser controis from a large cohort of 1039 healthy women, aged 31-89 years (OFELY study). Most users were taking combined oral contraceptives containing 30 itg ethinyi estradiol and the mean duration of pill use was 6.7-6.4 years. Users and nonusers were matched for age [mean age (years): 39.3 "4-3.5 vs. 40.5-+ 4.3, range 35-49 years for both]. Main outcome measures included three markers of bone formation (serum osteocalcin, bone-specific alkaline phosphatase, and C-terminal propeptide of type I collagen) and two markers of bone resorption that are pyridinoline crosslinked peptides (Crosslaps TM and NTX). Users and nonusers did not differ for weight, height, alcohol and tobacco use, dietary calcium intake, parity, exercise activity, body fat and lean composition, and calcium chemistry tests. In pill users all bone formation and resorption markers were decreased compared with controis: osteocalcin, 7.7-2.7 vs. 10.1-+ 3.1 ng/mL (-24%, p < 0°001); bone-specific alkaline phosphatase, 7.5-+ 2.3 vs. 8.8-2.7 ng/mL (-15%, p < 0.003); C-terminal propeptide of type I collagen, 77.2-93.1 vs. 93.1-31.9 ng/mL (-17%, p = 0.001); Crosslaps~M: 175-91 vs. 211-+ 105 p.g/mmoi Cr (-17%, p = 0.03); and NTX, 16.2-5.9 vs. 22.5-+ 9.4 nmol of bone collagen equivalent/mmol Cr (-28%, p < 0.001). There was no significant difference in whole body BMC and BMD, lumbar spine, total hip, and distal radius BMD between oral contraceptive users and controls. Oral contraception is associated with a moderate, but significant, decrease in bone turnover that may have a beneficial influence on bone mass only after prolonged use. However, given the large interindividual variability of bone mass, such an effect could not be established by this cross-sectional study and a longitudinal design is required.
Obstetrics & Gynecology, 2000
Objective: To evaluate relationships between bone mineral density and use of steroid hormonal contraceptives. Methods: This was a multicenter cross-sectional study in seven centers in three regions of the developing world from April 1994 to June 1997. Women 30-34 years old attending family planning clinics, with at least 24 months of lifetime use of combined oral contraceptives (OC), depotmedroxyprogesterone acetate (DMPA), or levonorgestrel implants, or no or only short-term (less than 6 months) use of steroid hormonal contraceptives, had bone mineral density (BMD) measured at the distal radius and the midshaft of the ulna using single-photon x-ray absorptiometry. Results: In the study, 2474 women were examined. For OC use, adjusted mean BMD was significantly higher in shortterm, current users compared with women who never used hormonal contraceptives. For DMPA and levonorgestrel implants, adjusted mean BMD was statistically significantly lower in short-term current users compared with those who never used hormonal contraceptives. For all three hormonal methods, there were no significant differences in BMD between past users of hormonal contraceptives and never users, even among those who had used the methods for 4 or more years. The magnitude of changes in BMD was small and less than one standard deviation (SD) from the mean of those who never used steroid contraceptives. Conclusion: This study suggests that hormonal contraceptive use by young adult women is associated with small changes in BMD that occur early after initiation of use and are reversible. (Obstet Gynecol 2000;95:736-44 © 2000 by The American College of Obstetricians and Gynecologists.) Many factors influence bone mass and the risk of osteoporotic fracture. 1 In women, the hypoestrogenic state is a determinant of bone mass and fracture risk. 1 Bone mass begins to increase at the time of menarche, 2 continues to increase until the late 20s to early 30s, 3 and then begins to decrease. Peak bone mass determines the risk for osteoporotic fracture. 2 The factors that influence peak bone mass are not fully understood. 2 Hormonal contraceptive use might influence bone mass. Combined oral contraceptives (OCs) have no effect or possibly protect against age-related loss of bone mass, 4 whereas the progestogen-only contraceptive depotmedroxyprogesterone acetate (DMPA) has been associated with reduced bone mass. 5-7 This study, done in a multiethnic international population, assessed bone mass according to steroid hormonal contraceptive use in women 30-34 years old. Materials and Methods This cross-sectional study was done at seven centers in three regions of the developing world
CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, 2001
Positive and negative effects on bone mineral density (BMD) have been described as a result of the premenopausal use of oral contraceptives (OCs); increased fracture rates have also been reported. This study assessed the relation between OC use and BMD in a population-based, 9-centre, national sample of women aged 25-45 years. Premenopausal women who had been enrolled in the Canadian Multicentre Osteoporosis Study were classified as having ever been OC users (> or = 3 months) or as having never been OC users (0 to < 3 months). Data were obtained through extensive questionnaires and measuring of participants' weight, height and the BMD of lumbar vertebrae and the proximal femur. Of the sample of 524 women, whose mean age was 36.3 (standard deviation [SD] 5.9) years, 454 had used OCs; their mean age when they started using OCs was 19.8 (SD 3.5) years and the mean duration of use was 6.8 (SD 4.8) years. Women who had ever and those who had never used OCs showed no differences...
Maturitas, 1994
In a 2-year longitudinal, calcium-controlled study we evaluated bone density and metabolism in perimenopausal women with initial ovarian failure, and the effects of hormone replacement with a low dose oral contraceptive preparation (OC). In perimenopausal oligomenorrhoic women (n = 16) a significant (P < 0.01) increase in cycle length and plasma FSH levels as well as a parallel decrease in plasma estradiol levels (P < 0.01) were evident. In this group, despite the calcium supplementation (500 mg/day), a significant (P < 0.001) increase in the biochemical markers of bone remodelling paralleled a significant (P < 0.001) decrease (-3.4% after 24 months) in bone density. Conversely, in premenopausal oligomenorrhoic women treated with a low dose oral contraceptive (CC) formulation (30 mcg ethinyl estradiol plus 75 mcg gestodene, n = 16), bone markers showed a significant (P < 0.01) decrease, that paralleled a slight but significant (P < 0.01) increase (+ 1.71%) in bone density. These data suggest that premenopausal administration of OC can prevent the acceleration of bone turnover and reverse the decrease in bone density that follows the premenopausal impairment of ovarian function.
Bone, 2007
The aim of this cross-sectional analysis was to examine the skeletal effects of low-dose monophasic oral contraceptive (OC) use in a cohort of 248 young Caucasian women aged 18-24 years. Areal bone mineral density (BMD) of the femoral neck and lumbar spine was evaluated by dual-energy X-ray absorptiometry. Volumetric BMD, bone mineral content (BMC), and bone geometry were assessed in the tibia by peripheral quantitative computed tomography (pQCT). The women were allocated into ever or never OC users, and also into 5 different OC groups according to duration and time of initiation of OC use. Women with > 2 years of OC use and OC initiation within 3 years after menarche were characterized by 10% lower femoral neck areal BMD (P < 0.001), 5% lower spine areal BMD (not significant, P = 0.101), 7% lower distal tibial total BMC (P < 0.05), and 6% lower total BMC at the tibial shaft (P < 0.05) relative to never users. In addition, women who had ever used OCs had lower bone mass at the femoral neck and tibial shaft, despite similar age, height, weight, BMI, hours of exercise, and calcium intake compared with never users. At the tibial shaft, OC users showed reduced total cross-sectional area, and increased cortical BMD. In conclusion, our data suggest that OC use is associated with a detrimental effect on bone mass in young women, and provide further insight into the pathophysiological mechanisms involved.
Oral contraceptive use and bone density in adolescent and young adult women
Contraception, 2010
Background: Most of the millions of oral contraceptive (OC) users are under 30 years of age and in the critical period for bone mass accrual. Study Design: This cross-sectional study of 606 women aged 14-30 years examined both OC duration and estrogen dose and their association with bone mineral density (BMD) at the hip, spine, and whole body (dual-energy X-ray absorptiometry). Results: Of 389 OC users and 217 nonusers enrolled, 50% were adolescents (14-18 years). Of OC users, 38% used "low-dose" OCs [b30 mcg ethinyl estradiol (EE)]. In adolescents, mean BMD differed by neither OC duration nor EE dose. However, 19-to 30-year-old women's mean BMD was lower with longer OC use for spine and whole body (p=.004 and p=.02, respectively) and lowest for N12 months of low-dose OCs for the hip, spine and whole body (p=.02, .003 and .002, respectively). Conclusions: Prolonged use of today's OCs, particularly b30 mcg EE, may adversely impact young adult women's bone density while using these agents.