Table 7

 Oligo/amenorrhoeic 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; RCT, randomised controlled trial; EE, ethinyl oestradiol; DXA, dual energy x ray absorptiometry; DPA, dual photon absorptiometry; SPA, single photon absorptiometry; NS, non-significant;’.
RCT (level 1b)Hergenroeder et al6224 women with hypothalamic amenorrhoea (ages 14–28)35 μg EE+0.5–1 mg norethindrone (n = 5) v 10 mg medroxyprogesterone (n = 5) v placebo (n = 5) for 12 monthsLumbar spine, total body, femoral neck DXAIncrease in lumbar spine & total body BMD in OC treated group v placebo; no change in BMD at any site in medroxyprogesterone treated group
Castelo-Branco et al6364 women with hypothalamic oligomenorrhoea (ages 19–35)30 μg EE+0.15 mg desogestrel (n = 24) v 20 μg EE+0.15 mg desogestrel (n = 22) v control (n = 18) for 12 monthsLumbar spine DXAIncrease in lumbar spine BMD in both OC treated groups; decrease in BMD in control group
Cohort (level 2b,64,67,68 level 465,66)De Creé et al6411 sportswomen with athletic menstrual irregularity (ages 18–29)50 μg EE+2 mg cyproterone acetate (n = 7) v control (n = 4) for 8 monthsLumbar spine DPA, radius SPA9.5% increase in lumbar spine BMD in OC treated group
Gulekli et al6585 women with past (n = 33) or current (n = 52) history of amenorrhoea (ages 17–40)Synthetic oestrogens (10–50 μg EE) (n = 40) v natural oestrogens (Premarin or oestradiol valerate) (n = 10) v 50 mg transdermal estradiol (n = 8) v bromocriptine (n = 9) v weight gain (n = 6) v control (untreated) (n = 12) for 3 yearsLumbar spine DXAIncrease in BMD in all treatment groups, but weight gain was most effective treatment; NS decrease in BMD in control group
Haenggi et al6621 women with hypothalamic or ovarian amenorrhoea, 123 healthy controls (ages 18–45)30 μg EE+0.15 mg desogestrel (n = 15) v control (n = 123) for 24 monthsLumbar spine, proximal femur DXAInitial BMD was lower in amenorrhoeic women than in healthy women; increase in lumbar spine, Ward’s triangle BMD in OC treated group
Cumming6713 female runners with amenorrhoea (ages 23–34)Oestrogen treated (0.0625 mg conjugated oestrogen (n = 6) or 50 μg transdermal estradiol (n = 2)) v control (n = 5) for 24 monthsLumbar spine, femoral neck, Ward’s triangle DXAIncrease in lumbar spine, femoral neck BMD in oestrogen treated group; NS decrease in BMD in control group
Rickenlund et al6838 women (26 athletes (13 eumenorrhoeic, 13 oligoamenorrhoeic), 12 eumenorrhoeic non-athletes) (ages 16–35)Each group received 30 μg EE+150 μg levonorgestrel for 10 monthsLumbar spine, total body DXA before and after 10 months of OC useIncrease in lumbar spine BMD in oligoamenorrhoeic athletes (especially those with low BMD at baseline); increase leg BMD in eumenorrhoeic athletes (related to weight-bearing exercise?)