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Effect of progestogen-only contraception on premenopausal fracture risk: a case-control study

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Abstract

Summary

Our study demonstrated that progestogen-only oral and intrauterine contraceptives are not associated with fracture risk independent from age.

Purpose

The use of progestogen-only contraception, resulting in a hypoestrogenic state, has been associated with impaired bone acquisition and increased fracture risk. The aim of this large population-based study was to assess the fracture risk in association with the use of progestogen-only contraceptives (progestogen-only pills (POPs) and progestogen-containing IUDs (LNG-IUD)).

Methods

We identified 14,421 women between 16 and 55 years of age with a first-time diagnosis of fracture and matched them with 14,421 random controls using the Disease Analyzer Database.

Results

The results of the first adjusted logistic regression model (ever use vs. never use of progestogen-only contraceptives) revealed that there was no significant association between the use of POPs (OR = 0.98, 95% CI 0.90–1.07, p = 0.657) or LNG-IUDs (OR = 0.99, 95% CI 0.81–1.21, p = 0.945) and fracture incidence. Also, in the second regression model, we observed no effect of duration of use of POPs (OR = 1.01, 95% CI 0.98–1.03, p = 0.672) or LNG-IUDs (OR = 0.94, 95% CI 0.87–1.02, p = 0.177) on fracture occurrence. We also observed no effect in different age groups.

Conclusion

Our study results indicate that progestogen-only contraception (either POPs or LNG-IUPs) is not associated with fracture risk and may be considered a bone-safe option for adults and adolescents.

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Authors and Affiliations

  1. Department of Obstetrics and Prenatal Medicine, Asklepios Clinics Barmbek, Heidberg-Nord and Wandsbek, Hamburg, Germany

    I. Kyvernitakis

  2. Department of Obstetrics and Prenatal Medicine, Asklepios Clinic Barmbek, Rübenkamp 220, 22307, Hamburg, Germany

    I. Kyvernitakis

  3. Philipps University of Marburg, Marburg, Germany

    I. Kyvernitakis & P. Hadji

  4. Department of Epidemiology,, IQVIA, Frankfurt, Germany

    K. Kostev

  5. Frankfurt Center of Bone Health, Frankfurt, Germany

    F. Thomasius & P. Hadji

  6. Department of General, Trauma, and Reconstructive Surgery, Munich University Hospital LMU, Munich, Germany

    U. Stumpf

Authors
  1. I. Kyvernitakis
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  2. K. Kostev
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  3. F. Thomasius
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  4. U. Stumpf
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  5. P. Hadji
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Correspondence to I. Kyvernitakis.

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Kyvernitakis, I., Kostev, K., Thomasius, F. et al. Effect of progestogen-only contraception on premenopausal fracture risk: a case-control study. Osteoporos Int 31, 1801–1806 (2020). https://doi.org/10.1007/s00198-020-05437-6

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  • DOI: https://doi.org/10.1007/s00198-020-05437-6

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