Table 4

 Healthy premenopausal 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; 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 al16156 college age womenCurrent OC users (n = 34) v past users (n = 43) v neverForearm SPA; spine, total body DPATotal body (but not forearm, spine) BMD positively correlated with OC use
Berenson et al17155 white, black, Asian, Hispanic women (ages 18–33) in the Armed Forces35 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 monthsLumbar spine DXAIncrease in BMD in OC groups (norethindrone 2.33% increase in BMD; desogesterel 0.33% increase in BMD)
Elgán et al18118 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-PYROC 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 sectionalGoldsmith & Johnston192199 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 absorptiometryOCs containing ⩾100 μg mestranol increase bone mineralisation (but OCs containing 50–80 μg mestranol or 50–100 μg EE did not)
Lindsay et al2057 women (ages 25–35)Ever OC users (30 or 50 μg EE+norgestrel, n = 24) v never usersLumbar spine DPA12% higher BMD in ever OC users than in never users
Kleerekoper et al212297 women (24% pre-, 76% post-menopausal)29.7% ever OC users v 68.5% never OC users (1.8% missing)Forearm SPA, lumbar spine DPASignificant association between duration of OC use and BMD (greatest in those with ⩾10 years OC use)
Laitinen et al22293 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 DXASignificant correlation between OC use and BMD in premenopausal women
Pasco et al23710 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 DXA3.3% greater mean lumbar spine BMD in premenopausal ever OC users than in never users
Cobb et al24476 black & white women (ages 18–30)Lifetime month by month OC history by questionnaire (quantitative measure)Spine, whole body, hip DXASignificant correlation between spinal BMD and cumulative OC exposure in white but not black women
Wallace & Ballard2542 white women (ages 19–25)Current OC users (n = 20) v non-users (n = 22)Lumbar spine, total hip femoral neck, trochanter total body DXASignificant correlation between trochanteric, total hip BMD and OC use