Table 7

Oligo/amenorrhoeic 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; 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 al⁶²	24 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 months	Lumbar spine, total body, femoral neck DXA	Increase in lumbar spine & total body BMD in OC treated group v placebo; no change in BMD at any site in medroxyprogesterone treated group
RCT (level 1b)	Castelo-Branco et al⁶³	64 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 months	Lumbar spine DXA	Increase in lumbar spine BMD in both OC treated groups; decrease in BMD in control group
Cohort (level 2b,^64,^67,⁶⁸ level 4^65,⁶⁶)	De Creé et al⁶⁴	11 sportswomen with athletic menstrual irregularity (ages 18–29)	50 μg EE+2 mg cyproterone acetate (n = 7) v control (n = 4) for 8 months	Lumbar spine DPA, radius SPA	9.5% increase in lumbar spine BMD in OC treated group
	Gulekli et al⁶⁵	85 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 years	Lumbar spine DXA	Increase in BMD in all treatment groups, but weight gain was most effective treatment; NS decrease in BMD in control group
	Haenggi et al⁶⁶	21 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 months	Lumbar spine, proximal femur DXA	Initial BMD was lower in amenorrhoeic women than in healthy women; increase in lumbar spine, Ward’s triangle BMD in OC treated group
	Cumming⁶⁷	13 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 months	Lumbar spine, femoral neck, Ward’s triangle DXA	Increase in lumbar spine, femoral neck BMD in oestrogen treated group; NS decrease in BMD in control group
	Rickenlund et al⁶⁸	38 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 months	Lumbar spine, total body DXA before and after 10 months of OC use	Increase 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?)