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Oral contraceptive use, bone mineral density, and bone turnover markers over 12 months in college-aged females



The purpose of this study was to compare bone mineral density (BMD) and bone turnover markers between combined oral contraceptive (COC) and non-COC users over 12 months.

Materials and methods

COC users (n = 34, age = 19.2 ± 0.5) and non-COC users (n = 28, age = 19.3 ± 0.6) provided serum at baseline, 6 months, and 12 months. C-terminal telopepetides (CTX) and pro-collagen type 1 N-terminal propeptides (P1NP) were determined using ELISA. BMD was measured at the three time points using dual-energy x-ray absorptiometry (DXA).


COC users had greater CTX than non-COC users at baseline (18.6 ± 8.2 vs. 13.8 ± 5.3 ng/mL, P = 0.021) and 6 months (20.4 ± 10.3 vs. 14.2 ± 8.5 ng/mL, P = 0.018). Controlling for lean mass, groups were similar in BMD. Over 12 months, non-COC users maintained BMD at the spine, while the COC users declined 2.2% in lateral spine BMD (0.773 ± 0.014 to 0.756 ± 0.014 g/cm2, P = 0.03) and 0.7% in anterior–posterior spine BMD (1.005 ± 0.015 to 0.998 ± 0.015 g/cm2, P = 0.069). Non-COC users increased in BMD of the whole body over 12 months (P < 0.001) while COC users had no change. Women who began COCs within 4 years after menarche had lower BMD at the hip and whole body. Women taking very low dose COCs (20 mcg ethinyl estradiol, EE) significantly declined in CTX, P1NP, and lateral spine BMD in comparison to participants using low dose COCs (30/35 mcg EE).


College-aged women who did not use COCs increased BMD of the whole body, while COC users had elevated bone turnover, declines in spinal BMD, and lack of bone acquisition of the whole body over 12 months. Young females who initiate COC use early after menarche may experience skeletal detriments.

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This research was funded by the National Institute of Alcohol Abuse and Alcoholism at the National Institute of Health with Grant number R21AA022942. Support was also provided by the Frank R. Seaver College of Science and Engineering, the Bellarmine College of Liberal Arts, and the Rains Research Assistance program at Loyola Marymount University. We are grateful for all of the participants who volunteered for the investigation. We acknowledge Sarah Boyle, Andrew Earle, Angie Flores, Nicole Froidevaux, Danielle Good, Carolyn Jackson, Caitlin Jennings, Shantay Pierre, Todd Shoepe, and Liam Shorrock for their valuable contributions to this project. We also appreciate the many people who worked as part of the SELFY research team including Olivia Abdoo, Kate Collins, Kelsey Crispeno, Christa Demos, Zoe Daily, Isabella Kuroyama, Stephanie Lee, Haley Loeffler, Allison Leggett, Diana Martinez, Sydnie Maltz, Grant Mello, Savannah Mersola, Nhandi Scott, Fiona Shorrock, Alejandra Silva, Daniel Smith, and Lauren Sutherlin.

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Authors and Affiliations



HCA developed methodology and performed conceptualization, formal analysis, investigation, data curation, writing, project administration, and funding acquisition. MMC and LFB were responsible for data curation, formal analysis, and contributed to writing. DVD contributed to methodology, formal analysis, investigation, and writing. JWL was involved with data curation, methodology, supervision, project administration, and funding acquisition.

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Correspondence to Hawley C. Almstedt.

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All authors have no conflicts of interest.

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All the procedures performed in this study were in accordance with the ethical standards of the Human Subject’s Institutional Review Board at Loyola Marymount University and with the 1964 Helsinki Declaration and its later amendments.

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All volunteers provided informed consent for procedures and scientific data use before initiating participation, as is standard at our University.

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Almstedt, H.C., Cook, M.M., Bramble, L.F. et al. Oral contraceptive use, bone mineral density, and bone turnover markers over 12 months in college-aged females. J Bone Miner Metab 38, 544–554 (2020).

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  • Peak bone mass
  • Menarche
  • Premenopausal
  • CTX
  • P1NP