Table 13

 Perimenopausal women: positive effect of oral contraceptives on bone mineral density

Study designReferenceNo of patientsOC exposureMeasurement of BMD/bone metabolismResults
OC, Oral contraceptive; BMD, bone mineral density; RCT, randomised controlled trial; DXA, dual energy x ray absorptiometry; NS, non-significant; EE, ethinyl oestradiol; CT, computed tomography; DPA, dual photon absorptiometry; SPA, single photon absorptiometry.
RCT (level 1b)Volpe et al8017 perimenopausal women (ages 46–53)OC treated (n = 8) v control (n = 9) for 36 monthsSpine DXANS increase in BMD in OC users, decrease in BMD in non-users
Cohort (level 2b,81,83,84 level 482)Shargil81200 perimenopausal women (ages 41–49)Triphasic OC (30 μg EE+0.05 mg levonorgestrel x6, 40 μg EE+0.075 mg levonorgestrel x5, 30 μg EE+0.125 mg levonorgestrel x10) (n = 100) v control (n = 100) for 36 monthsLumbar spine, hand bone mass x ray/CTNo change in OC users v 6% decrease in BMD in controls
Gambacciani et al8232 perimenopausal oligomenorrhoeic women30 μg EE+75 μg gestodene (n = 16) v 500 mg Ca2+ (n = 16) for 24 monthsRadius DPAIncrease BMD with OC use
Gambacciani et al8390 perimenopausal (27 eumenorrhoeic, 54 oligomenorrhoeic) women20 μg EE+0.15 mg desogestrel (n = 27) v500 mg Ca2+ (n = 27) for 24 monthsLumbar spine DXAIncrease in BMD with OC use v decrease BMD with calcium
Gambacciani et al8455 perimenopausal (18 eumenorrhoeic, 37 oligomenorrhoeic) women20 μg EE+0.15 mg desogestrel v 500 mg Ca2+ for 24 monthsFemoral neck, Ward’s triangle, trochanter DXAIncrease in femoral neck BMD from baseline with OC use v decrease in femoral neck, Ward’s triangle, trochanter BMD from baseline with calcium
Cross sectionalEnzelsberger et al85200 perimenopausal women>10years OC use (n = 30) v 2–9 years OC use (n = 50) v never use (n = 120)Forearm SPAOC use for >10 years associated with increase in BMD
Tuppurainen et al863222 perimenopausal women29% ever OC useLumbar spine, femoral neck DXAEver OC users had increase spinal BMD v never users
Masaryk et al872038 women (98 peri-, 1940 post-menopausal)18.3% ever OC useLumbar spine, hip DXAEver OC users had increase in spinal BMD v never users