Healthy premenopausal women: negative 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; EE, ethinyl oestradiol; DXA, dual energy x ray absorptiometry; BSAP, bone specific alkaline phosphatase; Cr, creatinine; SPA, single photon absorptiometry; DMPA, deoxymedroxyprogesterone acetate. | |||||
| Cohort (level 2b,58 level 455–57) | Polatti et al55 | 200 women (ages 19–22) | 20 μg EE+0.15 mg desogestrel (n = 100) v control (n = 100) for 60 months | Lumbar spine DXA; serum BSAP, urinary hydroxyproline:Cr | No change in BMD in treated group v increase in BMD in control group; no change in BSAP or hydroxyproline levels in either group |
| Burr et al56 | 46 women (ages 18–31) | Non-exercisers/non-OC users (n = 10) v non-exercisers +⩽50 μg EE (n = 13) v exercisers/non-OC users (n = 8) v exercisers +⩽50 μg EE (n = 15) | Femoral neck DXA; serum osteocalcin, BSAP, acid phosphatase, urinary hydroxyproline:Cr | Either OC use or exercise alone is associated with suppression of the normal increase in femoral neck bone mass/mechanical strength; combination of OC use and exercise has less suppressive effect than either alone | |
| Weaver et al57 | 179 women (ages 18–31) | Non-exercisers/non-OC users (n = 40) v non-exercisers +⩽50 μg EE (n = 37) v exercisers/non-OC users (n = 37) v exercisers + ⩽50 μg EE (n = 40) | Lumbar spine, total body total hip DXA; radius SPA; serum osteocalcin, BSAP acid phosphatase, urinary hydroxyproline:Cr | Significant interaction between OC use and exercise, such that a combination of OC use and exercise compromises attainment of peak spinal BMD | |
| Cromer et al58 | 215 women (ages 12–18) | 20 μg EE+100 μg levonorgestrel (n = 79) v DMPA (n = 29) v control (n = 107) over 12 months | Lumbar spine, total hip, femoral neck, Ward’s triangle, trochanter DXA | Increase in spine and hip BMD in both OC and control groups, but increase in OC group was significantly less than that in control group | |
| Cross sectional | Hartard et al59 | 128 women (ages 20–35) | Long term exercise/short term use (n = 30) v long term exercise/long term OC use (n = 37) v short term exercise/long term OC use (n = 31) v short term exercise/short term OC use (n = 30) | Lumbar spine, femoral neck DXA | Highest BMD in long term exercise/short term OC use group; no differences in mean BMD between short term exercise/long term OC use and short term exercise/short term OC use; overall, OC use counteracts beneficial effect of exercise on BMD? |
| Prior et al60 | 524 women (ages 25–45) | Ever OC users (for ⩾3 months) (n = 454) v never users (0 to <3 months) (n = 70) | Lumbar spine, proximal femur DXA | Decrease in lumbar spine, trochanter BMD in ever OC users v never users | |
| Hartard et al61 | 69 female endurance athletes (ages18–35) | OC group (use for >3years in women <22years old or use for >50% of time after menarche in women age 22–35) (n = 31) v control (n = 38) | Lumbar spine, hip DXA | OC users had 7.9% lower lumbar spine and 8.8% lower proximal femur BMD than control | |