Abstract
The bone mineral density (BMD) of the lumbar vertebrae L2–4 and femoral neck was determined by dual-energy X-ray absorptiometry (DXA) in 3222 perimenopausal women — a random stratified sample of the population-based Kuopio Osteoporosis Study (OSTPRE). The mean age of the women was 53.4 years (range 47.9–59.6 years). Twenty-nine percent of the women were past users of oral contraceptives (OC) containing 50 µg or less of ethinyl estradiol and 7.4% (n=250) of the women reported OC use for more than 6 years. There was a slight but statistically significant difference between OC users (n=939) and non-users (n=2283) in lumbar BMD (1.134±0.155 g/cm2 v 1.123±0.161 g/cm2,p=0.014). A statistically significant difference was recorded also after adjustment for years since menopause, duration of hormonal replacement therapy (HRT) and present weight (p=0.044). When the analysis was performed among women who had never used oestrogen replacement therapy (n=1427) and among premenopausal women (n=387), no differences in BMD were found between OC users and non-users. Similarly, femoral neck BMD did not differ between the groups. This population-based study demonstrated a slightly higher lumbar BMD among past OC users. However, OC users and non-users differed from each other in many behavioral characteristics. Thus, the differences in BMD may be accounted for more by other factors than by past OC use itself. The low-dosage estrogen OCs used today would not be expected to have any positive bone effects among future perimenopausal women.
Similar content being viewed by others
References
Riggs BL. Pathogenesis of osteoporosis. Am J Obstet Gynecol 1987;156:1342–6.
Lindsay R, Hart DM, Forrest C, Baird C. Prevention of spinal osteoporosis in oophorectomised women. Lancet 1980;2:1151–4.
Prior JC, Vigna YM, Schecter MT, Burgess AE. Spinal bone loss and ovulatory disturbances. N Engl J Med 1990;323:1221–7.
Rigotti NA, Nussbaum, SR, Herzog DB, Neer RM. Osteoporosis in women with anorexia nervosa. N Engl J Med 1984;311:1601–6.
Drinkwater B, Brumner B, Chestnut C. Menstrual history as a determinant of current bone density in young athletes. JAMA 1990;263:545–8.
Lindsay R. Estrogen therapy in the prevention and management of osteoporosis. Am J Obstet Gynecol 1987;156:1347–51.
Goldsmith NF, Johnston JO. Bone mineral: effects of oral contraceptives, pregnancy, and lactation. J Bone Joint Surg [Am] 1975;57:657–68.
Shargil A. Hormone replacement therapy in perimenopausal women with a triphasic contraceptive compound: a three-year prospective study. Int J Fertil 1985;30:15–28.
Lindsay R, Tohme, J, Kanders B. The effect of oral contraceptive use on vertebral bone mass in pre- and post-menopausal women. Contraception 1986;34:333–40.
Enzelsberger H, Metka M, Heytmanek G, Schurz B, Kurz C, Kusztrich M. Influence of oral contraceptive use on bone density in climacteric women. Maturitas 1988;9:375–8.
Kleerekoper M, Brienza RS, Schultz LR, Johnson CC. Oral contraceptive use may protect against low bone mass. Arch Intern Med 1991;151:1971–6.
Laitinen K, Välimäki M, Keto P. Bone mineral density measured by dual-energy x-ray absorptiometry in healthy Finnish women. Calcif Tissue Int 1991;48:224–31.
Collins CL, Thomas KA, Harding AF, Cook SD, Turner JL, Collins JH. The effect of oral contraceptives on lumbar bone density in premenopausal women. J La State Med Soc 1988;140(9):31–9.
Lloyd T, Buchanan JR, Ursino GR, Myers C, Woodward G, Halbert DR. Long-term oral contraceptive use does not affect trabecular bone density. Am J Obstet Gynecol 1989;160:402–4.
Hreshchyshyn MM, Hopkins A, Zylstra S, Anbar M. Associations of parity, breastfeeding, and birth control pills with lumbar spine and femoral neck bone densities. Am J Obstet Gynecol 1988;159:318–22.
Rodin A, Chapman M, Fogelman I. Bone density in users of combined oral contraception: preliminary reports of a pilot study. B J Family Planning 1991;16:125–9.
Mehta S. Bone loss, contraception and lactation. Acta Obstet Gynecol Scand 1993;72:148–56.
Cooper C, Hannaford P, Croft P, Kay R. Oral contraceptive pill use and fractures in women: a prospective study. Bone 1993;14:41–5.
Honkanen R, Alhava E, Saarikoski S, Tuppurainen M. Osteoporosis risk factors in perimenopausal women. Calcif Tissue Int 1991;Suppl 49:74–5.
Tuppurainen M, Honkanen R, Kröger H, Saarikoski S, Alhava E. Osteoporosis risk factors, gynaecological history and fractures in perimenopausal women: the results of the baseline postal enquiry of the Kuopio Osteoporosis Risk Factor and Prevention Study. Maturitas 1993;17(2):89–100.
Kröger H, Heikkinen J, Laitinen K, Kotaniemi A. Dual-energy X-ray absorptiometry in normal women: a cross-sectional study of 717 Finnish volunteers. Osteoporosis Int 1992;2:135–40.
Abdalla HI, McKay Hart D, Lindsay R, et al. Prevention of bone mineral loss in postmenopausal women by Norethisterone. Obstet Gynecol 1985;66:789–91.
Goulding A, McChesney R. Oestrogen-progestogen oral contraceptives and urinary calcium excretion. Clin Endocrinol 1977;6:449–54.
Riggs BL, Jowsey J, Kelly PJ, Jones JD, Maher FT. Effect of sex hormones on bone in primary osteoporosis. J Clin Invest 1969;48:1065–72.
Mishell DR, Thorneycroft IH, Nakamura RM, et al. Serum estradiol in women ingesting combination oral contraceptive steroids. Am J Obstet Gynecol 1972;114:923–8.
Cundy T, Evans M, Roberts H, Wattie D, Ames R, Reid IR. Bone density in women receiving depot medroxyprogesterone acetate for contraception. BMJ 1991;303:13–6.
Dequeker J, Tobing L, Rutten V, Geusens R. Relative risk factors for osteoporotic fracture: a pilot study of the MEDOS questionnaire. Clin Rheumatol 1991;10:49–53.
Mazess R, Barden HS. Bone density in premenopausal women: effects of age, dietary intake, physical activity, smoking, and birth-control pills. Am J Clin Nutr 1991;53:132–42.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Tuppurainen, M., Kröger, H., Saarikoski, S. et al. The effect of previous oral contraceptive use on bone mineral density in perimenopausal women. Osteoporosis Int 4, 93–98 (1994). https://doi.org/10.1007/BF01623231
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF01623231