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Steroidal contraceptive use is associated with lower bone mineral density in polycystic ovary syndrome

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An Erratum to this article was published on 29 February 2016

Abstract

Polycystic ovary syndrome (PCOS) is a common condition affecting reproductive-aged women with features including hyperandrogenism and menstrual irregularity frequently treated with hormonal steroidal contraceptives. Women with PCOS appear to have lower bone mineral density (BMD). While steroidal contraceptives may positively affect bone health, their effect on BMD in PCOS is not known. The aim of this study was to assess BMD in women with PCOS according to recent contraceptive use. A cross-sectional analysis of 95 pre-menopausal overweight or obese sedentary women with PCOS [age 29.4 ± 6.4 years, body mass index (BMI) 36.1 ± 5.3 kg/m2] who either recently took steroidal contraceptives (ceased 3 months prior) or were not taking steroidal contraceptives was conducted. Clinical outcomes included BMD, anthropometry, insulin, glucose, reproductive hormones, dietary intake and vitamin use. BMD was significantly lower for women who used contraceptives compared to those who did not (mean difference 0.06 g/cm2 95 % confidence interval −0.11, −0.02, p = 0.005). In regression models, lower BMD was independently associated with contraceptive use (β = −0.05, 95 % CI −0.094, −0.002, p = 0.042), higher testosterone (β = −0.03, 95 % CI −0.05, −0.0008, p = 0.043) and lower BMI (β = 0.006, 95 % CI 0.002, 0.01, p = 0.007) (r 2 = 0.22, p = 0.001 for entire model). We report for the first time that overweight and obese women with PCOS with recent steroidal contraceptive use had lower BMD in comparison to non-users independent of factors known to contribute to BMD. Whether this observation is directly related to steroidal contraceptive use or other factors requires further investigation.

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References

  1. H. Teede, A. Deeks, L. Moran, Polycystic ovary syndrome: a complex condition with psychological, reproductive and metabolic manifestations that impacts on health across the lifespan. BMC Med. 8, 41 (2010)

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  2. O. Yuksel, H.S. Dokmetas, S. Topcu, T. Erselcan, M. Sencan, Relationship between bone mineral density and insulin resistance in polycystic ovary syndrome. J. Bone Miner. Metabol. 19, 257–262 (2001)

    Article  CAS  Google Scholar 

  3. H.J. Teede, M.L. Misso, A.A. Deeks, L.J. Moran, B.G. Stuckey, J.L. Wong, R.J. Norman, M.F. Costello, Assessment and management of polycystic ovary syndrome: summary of an evidence-based guideline. Med. J. Aust. 195, S65–S112 (2011)

    Article  PubMed  Google Scholar 

  4. H. Michael, P.L. Harkonen, H.K. Vaananen, T.A. Hentunen, Estrogen and testosterone use different cellular pathways to inhibit osteoclastogenesis and bone resorption. J. Bone Miner. Res. 20, 2224–2232 (2005)

    Article  CAS  PubMed  Google Scholar 

  5. M. Vessey, J. Mant, R. Painter, Oral contraception and other factors in relation to hospital referral for fracture. Findings in a large cohort study. Contraception 57, 231–235 (1998)

    Article  CAS  PubMed  Google Scholar 

  6. R.L. Thomson, J.D. Buckley, M. Noakes, P.M. Clifton, R.J. Norman, G.D. Brinkworth, The effect of a hypocaloric diet with and without exercise training on body composition, cardiometabolic risk profile, and reproductive function in overweight and obese women with polycystic ovary syndrome. J. Clin. Endocrinol. Metabol. 93, 3373–3380 (2008)

    Article  CAS  Google Scholar 

  7. A. Hodge, A.J. Patterson, W.J. Brown, P. Ireland, G. Giles, The Anti Cancer Council of Victoria FFQ: relative validity of nutrient intakes compared with weighed food records in young to middle-aged women in a study of iron supplementation. Aust. N. Z. J. Public Health 24, 576–583 (2000)

    Article  CAS  PubMed  Google Scholar 

  8. S.F. Vondracek, L.B. Hansen, M.T. McDermott, Osteoporosis risk in premenopausal women. Pharmacotherapy 29, 305–317 (2009)

    Article  PubMed  Google Scholar 

  9. F. Wu, B. Mason, A. Horne, R. Ames, J. Clearwater, M. Liu, M.C. Evans, G.D. Gamble, I.R. Reid, Fractures between the ages of 20 and 50 years increase women’s risk of subsequent fractures. Arch. Intern. Med. 162, 33–36 (2002)

    Article  PubMed  Google Scholar 

  10. L.M. Lopez, D.A. Grimes, K.F. Schulz, K.M. Curtis, M. Chen, Steroidal contraceptives: effect on bone fractures in women. Cochrane Database Syst. Rev. 6, CD006033 (2014)

    PubMed  Google Scholar 

  11. A.B. Berenson, C.M. Radecki, J.J. Grady, V.I. Rickert, A. Thomas, A prospective, controlled study of the effects of hormonal contraception on bone mineral density. Obstet. Gynecol. 98, 576–582 (2001)

    Article  CAS  PubMed  Google Scholar 

  12. C. Castelo-Branco, F. Pons, M.J. Martinez de Osaba, J. Garrido, A. Fortuny, Menstrual history as a determinant of current bone density in young hirsute women. Metabolism 45, 515–518 (1996)

    Article  CAS  PubMed  Google Scholar 

  13. D. Kassanos, E. Trakakis, C.S. Baltas, O. Papakonstantinou, G. Simeonidis, G. Salamalekis, I. Grammatikakis, G. Basios, G. Labos, G. Skarantavos, A. Balanika, Augmentation of cortical bone mineral density in women with polycystic ovary syndrome: a peripheral quantitative computed tomography (pQCT) study. Hum. Reprod. 25, 2107–2114 (2010)

    Article  CAS  PubMed  Google Scholar 

  14. J. Yang, X. Zhang, W. Wang, J. Liu, Insulin stimulates osteoblast proliferation and differentiation through ERK and PI3K in MG-63 cells. Cell Biochem. Funct. 28, 334–341 (2010)

    Article  CAS  PubMed  Google Scholar 

  15. J. Schmidt, E. Dahlgren, M. Brannstrom, K. Landin-Wilhelmsen, Body composition, bone mineral density and fractures in late postmenopausal women with polycystic ovary syndrome—a long-term follow-up study. Clin. Endocrinol. 77, 207–214 (2012)

    Article  CAS  Google Scholar 

  16. J.A. Ruffing, J.W. Nieves, M. Zion, S. Tendy, P. Garrett, R. Lindsay, F. Cosman, The influence of lifestyle, menstrual function and oral contraceptive use on bone mass and size in female military cadets. Nutr. Metabol. 4, 17 (2007)

    Article  Google Scholar 

  17. R.P. Heaney, Calcium, dairy products and osteoporosis. J. Am. Coll. Nutr. 19, 83S–99S (2000)

    Article  CAS  PubMed  Google Scholar 

  18. D. Teegarden, P. Legowski, C.W. Gunther, G.P. McCabe, M. Peacock, R.M. Lyle, Dietary calcium intake protects women consuming oral contraceptives from spine and hip bone loss. J. Clin. Endocrinol. Metabol. 90, 5127–5133 (2005)

    Article  CAS  Google Scholar 

  19. S.A. Jamal, R. Ridout, C. Chase, L. Fielding, L.A. Rubin, G.A. Hawker, Bone mineral density testing and osteoporosis education improve lifestyle behaviors in premenopausal women: a prospective study. J. Bone Miner Res. 14, 2143–2149 (1999)

    Article  CAS  PubMed  Google Scholar 

  20. T. Winzenberg, B. Oldenburg, S. Frendin, L. De Wit, M. Riley, G. Jones, The effect on behavior and bone mineral density of individualized bone mineral density feedback and educational interventions in premenopausal women: a randomized controlled trial [NCT00273260]. BMC Public Health 6, 12 (2006)

    Article  PubMed Central  PubMed  Google Scholar 

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Acknowledgments

We gratefully acknowledge Julia Weaver for assisting with trial management; Lindy Lawson and Rosemary McArthur for their assistance in the nursing activities and Mark Mano, Cathryn Seccafien and Candita Sullivan for laboratory assistance. This project was funded by a grant from the National Health and Medical Research Council of Australia. R.T. was funded by a postgraduate scholarship from the South Australia Department of Health. L. M. is supported by a South Australian Cardiovascular Research Development Program Fellowship; a programme collaboratively funded by the National Heart Foundation, the South Australian Department of Health and the South Australian Health and Medical Research Institute.

Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. The Robinson Research Institute, School of Paediatrics and Reproductive Health, University of Adelaide, 55 King William Road, North Adelaide, SA, 5006, Australia

    Lisa J. Moran & R. J. Norman

  2. Alliance for Research in Exercise, Nutrition and Activity (ARENA), Sansom Institute for Health Research, University of South Australia, Adelaide, SA, Australia

    R. L. Thomson, J. D. Buckley & P. M. Clifton

  3. Fertility SA, Adelaide, SA, Australia

    M. Noakes & R. J. Norman

  4. CSIRO Food and Nutrition, Adelaide, SA, Australia

    G. D. Brinkworth

Authors
  1. Lisa J. Moran
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  2. R. L. Thomson
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  3. J. D. Buckley
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  4. M. Noakes
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  5. P. M. Clifton
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  6. R. J. Norman
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  7. G. D. Brinkworth
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Correspondence to Lisa J. Moran.

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Moran, L.J., Thomson, R.L., Buckley, J.D. et al. Steroidal contraceptive use is associated with lower bone mineral density in polycystic ovary syndrome. Endocrine 50, 811–815 (2015). https://doi.org/10.1007/s12020-015-0625-7

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  • DOI: https://doi.org/10.1007/s12020-015-0625-7

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