TY - JOUR
T1 - Oral contraceptive use and bone density change in adolescent and young adult women
T2 - A prospective study of age, hormone dose, and discontinuation
AU - Scholes, Delia
AU - Hubbard, Rebecca A.
AU - Ichikawa, Laura E.
AU - LaCroix, Andrea Z.
AU - Spangler, Leslie
AU - Beasley, Jeannette M.
AU - Reed, Susan
AU - Ott, Susan M.
PY - 2011/9
Y1 - 2011/9
N2 - Context: Oral contraceptive (OC) use is common, but bone changes associated with use of contemporary OC remain unclear. Objective: The objective of the study was to compare bone mineral density (BMD) change in adolescent and young adultOCusers and discontinuers of two estrogen doses, relative to nonusers. Design and Setting: This was a prospective cohort study, Group Health Cooperative. Participants: Participants included 606 women aged 14-30 yr (50% adolescents aged 14-18 yr): 389 OC users [62% 30-35 μg ethinyl estradiol (EE)] and 217 age-similar nonusers; there were 172 OC discontinuers. The 24-month retention was 78%. Main Outcome Measure: The main outcome measure was BMD measured at 6-month intervals for 24-36 months. Results:After 24 months, adolescents using 30-35 μg EE OCs, but not those using lower-dose OCs, had significantly smaller adjusted mean percentage BMD gains than nonusers at the spine [group means (95% confidence interval for between group differences) 1.32 vs. 2.26% (-1.89, -0.13%)] and whole body [1.45 vs. 2.03% (-1.29%, -0.13%)]. Adolescents who discontinued 30-35 μg EE OC showed significantly smaller gains than nonusers at the spine after 12 months [0.51 vs. 1.72% (-2.38%, -0.30%)]. Young adult OC users did not differ from nonusers. However, OC discontinuers of both doses differed significantly from nonusers at the spine 12 months after discontinuation [-1.32%<30 μg EE, -0.92% 30-35 μg EE vs. +0.27% nonusers (-2.48, -0.54, and -1.94%, -0.55%, respectively)]. Results were similar for mean absolute BMD change (grams per square centimeter). Conclusions: Both OC use and discontinuation were associated with BMD losses/smaller gains relative to nonusers (differences < 2% after 12-24 months for all skeletal sites). The clinical significance of these results regarding future fracture risk is unknown. Study of longer-term trends after discontinuation is needed.
AB - Context: Oral contraceptive (OC) use is common, but bone changes associated with use of contemporary OC remain unclear. Objective: The objective of the study was to compare bone mineral density (BMD) change in adolescent and young adultOCusers and discontinuers of two estrogen doses, relative to nonusers. Design and Setting: This was a prospective cohort study, Group Health Cooperative. Participants: Participants included 606 women aged 14-30 yr (50% adolescents aged 14-18 yr): 389 OC users [62% 30-35 μg ethinyl estradiol (EE)] and 217 age-similar nonusers; there were 172 OC discontinuers. The 24-month retention was 78%. Main Outcome Measure: The main outcome measure was BMD measured at 6-month intervals for 24-36 months. Results:After 24 months, adolescents using 30-35 μg EE OCs, but not those using lower-dose OCs, had significantly smaller adjusted mean percentage BMD gains than nonusers at the spine [group means (95% confidence interval for between group differences) 1.32 vs. 2.26% (-1.89, -0.13%)] and whole body [1.45 vs. 2.03% (-1.29%, -0.13%)]. Adolescents who discontinued 30-35 μg EE OC showed significantly smaller gains than nonusers at the spine after 12 months [0.51 vs. 1.72% (-2.38%, -0.30%)]. Young adult OC users did not differ from nonusers. However, OC discontinuers of both doses differed significantly from nonusers at the spine 12 months after discontinuation [-1.32%<30 μg EE, -0.92% 30-35 μg EE vs. +0.27% nonusers (-2.48, -0.54, and -1.94%, -0.55%, respectively)]. Results were similar for mean absolute BMD change (grams per square centimeter). Conclusions: Both OC use and discontinuation were associated with BMD losses/smaller gains relative to nonusers (differences < 2% after 12-24 months for all skeletal sites). The clinical significance of these results regarding future fracture risk is unknown. Study of longer-term trends after discontinuation is needed.
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U2 - 10.1210/jc.2010-3027
DO - 10.1210/jc.2010-3027
M3 - Article
C2 - 21752879
AN - SCOPUS:80052526431
SN - 0021-972X
VL - 96
SP - E1380-E1387
JO - Journal of Clinical Endocrinology and Metabolism
JF - Journal of Clinical Endocrinology and Metabolism
IS - 9
ER -
