Oral contraceptive use and bone mineral density in premenopausal women: cross-sectional, population-based data from the Canadian Multicentre Osteoporosis Study (original) (raw)
Related papers
Contraception, 2011
Background: The associations between oral contraceptive (OC) use, bone mineral density (BMD) and the risk of fractures remain controversial. Study Design: A cross-sectional study of 491 women aged 50-80 years was performed. We assessed OC use and fractures by questionnaire, and BMD and vertebral deformity by dual-energy x-ray absorptiometry. Results: Ever use of OC was associated with significantly higher BMD at the total body (6%, pb.001) and spine (4%; p=.05) (but not hip) after adjustment for confounders. There was also a significant association between duration of OC use and total body and spine BMD. Use of OCs for 5-10 years was associated with reduced vertebral deformity (adjusted odds ratio 0.46, 95% confidence interval 0.22-0.94). Conclusions: Oral contraceptive use and duration were associated with higher total body and spine BMD and a consistent reduction in vertebral deformities, although most associations did not reach significance. Crown
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.
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.
British Journal of Sports Medicine, 2006
Seventy five articles on the effect of oral contraceptives and other hormone replacement on bone density in premenopausal and perimenopausal women were reviewed. The evidence was appraised using the Oxford Centre for Evidence-Based Medicine levels of evidence. There is good evidence for a positive effect of oral contraceptives on bone density in perimenopausal women, and fair evidence for a positive effect in ''hypothalamic'' oligo/amenorrhoeic premenopausal women. There is limited evidence for a positive effect in healthy and anorexic premenopausal women. In hypothalamic oligo/ amenorrhoeic women, baseline bone density has been shown to be significantly lower than that in healthy controls, therefore the decision to treat is clinically more important. The ideal formulation(s) and duration of treatment remain to be determined by further longitudinal and prospective randomised controlled trials in larger subject populations.
Oral Contraceptive Use and Bone
Current Osteoporosis Reports, 2010
Sex hormones play a key role in bone homeostasis, and oral contraceptive (OC) use may affect bone mass in women. However, the nature of the association between OC use and bone remains controversial. This paper critically reviews studies on OC use and bone published between January 2009 and August 2010. Studies of OC use and bone mass mainly focus on adolescents or young adults and showed mixed results. Weak evidence suggests that OC use has no effect or a beneficial effect on bone mass, except in women commencing OCs shortly after menarche, and a consistently negative effect on bone turnover markers. A limited number of studies have examined the effect of ultra-low-dose OC (20 μg ethinyl estradiol) on bone mass in adolescents or young adults, and present conflicting results. The lack of randomized trials indicates that further high-quality prospective studies are required to investigate the effect of OC use on bone mass, particularly the optimal dose and timing of initiation of OC use in adolescents requiring contraception.
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
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.
Maturitas, 2006
Objectives: To evaluate the pattern of mineral density in eumenorrhoic and oligomenorrhoic perimenopausal women, and assess the effects of different low dose oral contraceptives (OC) on bone metabolism and spine bone density. Methods: Spine bone density was evaluated in a longitudinal 2-year follow-up, randomized, unblinded, uncontrolled clinical trial conducted in healthy, normally menstruating perimenopausal women, perimenopausal oligomenorrhoic women and in perimenopausal oligomenorrhoic women treated with an oral contraceptive containing 20 mcg ethinyl estradiol plus 0.15 mg desogestrel, 0.100 mg levonorgestrel, 0.75 mg of gestodene (n = 15 in each group). The results were analyzed by factorial or repeated measures analysis of variance, as appropriate. Results: During the observation period, in normal menstruating women there were no changes in menstrual cycle, plasma FSH and estradiol levels, and spine bone density. In oligomenorrhoic untreated women an increase in cycle length, with a concomitant decrease in plasma estradiol and an increase in plasma FSH levels were evidenced (p < 0.05). In this group a significant decrease in bone density (p < 0.05) occurred. In OC-treated women, a significant (p < 0.05) increase in bone density was observed, with no differences among different groups. Conclusion: Different progestins used in OC preparations do not modify the bone sparing effect of perimenopausal OC administration avoiding the decrease in bone density.