Healthy premenopausal women: positive effect of oral contraceptives on bone mineral density
| Study design | Reference | No of patients | OC exposure | Measurement of BMD/bone metabolism | Results |
|---|---|---|---|---|---|
| OC, Oral contraceptive; BMD, bone mineral density; SPA, single photon absorptiometry; DPA, dual photon absorptiometry; EE, ethinyl oestradiol; DMPA, deoxymedroxyprogesterone acetate; DXA, dual energy x ray absorptiometry; D-PYR, deoxypyridinoline. | |||||
| Cohort (level 2b,16,18 level 417) | Recker et al16 | 156 college age women | Current OC users (n = 34) v past users (n = 43) v never | Forearm SPA; spine, total body DPA | Total body (but not forearm, spine) BMD positively correlated with OC use |
| Berenson et al17 | 155 white, black, Asian, Hispanic women (ages 18–33) in the Armed Forces | 35 μg EE+1 mg norethindrone (n = 28) v 30 μg EE+0.15 mg desogestrel (n = 35) v 150 mg DMPA (n = 33) v control (n = 59) for 12 months | Lumbar spine DXA | Increase in BMD in OC groups (norethindrone 2.33% increase in BMD; desogesterel 0.33% increase in BMD) | |
| Elgán et al18 | 118 women (ages 18–26) | Non-smoker/non-OC users (n = 35) v smoker/non-OC user (n = 9) v non-smoker/OC user (n = 57) v smoker/OC user (n = 17) | Calcaneus DXA; urinary D-PYR | OC users had higher baseline and final BMDs; smoking was associated with a larger negative change in BMD than in non-smokers; overall, OC use moderated negative impact of smoking | |
| Cross sectional | Goldsmith & Johnston19 | 2199 pre- and post-menopausal women (ages 15–79) | OC users (⩾100 μg mestranol, n = 332; <100 μg mestranol, n = 136; 50–100 μg EE, n = 83) v non-users (n = 1118) | Distal radius 125I photon absorptiometry | OCs containing ⩾100 μg mestranol increase bone mineralisation (but OCs containing 50–80 μg mestranol or 50–100 μg EE did not) |
| Lindsay et al20 | 57 women (ages 25–35) | Ever OC users (30 or 50 μg EE+norgestrel, n = 24) v never users | Lumbar spine DPA | 12% higher BMD in ever OC users than in never users | |
| Kleerekoper et al21 | 2297 women (24% pre-, 76% post-menopausal) | 29.7% ever OC users v 68.5% never OC users (1.8% missing) | Forearm SPA, lumbar spine DPA | Significant association between duration of OC use and BMD (greatest in those with ⩾10 years OC use) | |
| Laitinen et al22 | 293 Finnish women (186 pre-, 95 post- menopausal, 12 unknown; ages 20–76) | Premenopausal women: ever OC users (n = 65) v never users (n = 121) | Lumbar spine, proximal right femur DXA | Significant correlation between OC use and BMD in premenopausal women | |
| Pasco et al23 | 710 Australian women (511 pre-, 172 post- menopausal, 27 unknown; ages 20–69) | Ever OC users (n = 579) v never users (n = 131) | Lumbar spine, proximal femur, whole body, distal forearm DXA | 3.3% greater mean lumbar spine BMD in premenopausal ever OC users than in never users | |
| Cobb et al24 | 476 black & white women (ages 18–30) | Lifetime month by month OC history by questionnaire (quantitative measure) | Spine, whole body, hip DXA | Significant correlation between spinal BMD and cumulative OC exposure in white but not black women | |
| Wallace & Ballard25 | 42 white women (ages 19–25) | Current OC users (n = 20) v non-users (n = 22) | Lumbar spine, total hip femoral neck, trochanter total body DXA | Significant correlation between trochanteric, total hip BMD and OC use | |