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Oral contraceptive use in young women is associated with lower bone mineral density than that of controls

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Abstract

Osteoporosis is a skeletal disease affecting 44 million Americans. A primary strategy to prevent osteoporosis is to develop a high peak bone mass in youth. Oral contraceptives (OCs) alter hormones in women and could affect bone mass development. Fifty percent of American women between the ages of 20 and 24 years use OCs. However, the interaction between OCs and skeletal mineralization is poorly understood. Our aim was to compare bone mass [bone mineral density (BMD)] of young women who had a history of OC use, with regularly menstruating controls. We recruited 98 women who were 18 to 25 years of age and had a history of OC use (n=44, 3.4±1.9 years of OC use) and controls (n=58). BMD at the hip, whole-body, and spine [anterior-posterior (AP) and lateral grams per square centimeter] was measured by dual-energy X-ray absorptiometry (DXA). Physical activity [in metabolic equivalents (METs)] was measured via questionnaire, and grip strength was evaluated with an isometric dynamometer. Groups were similar in body mass index (BMI), fat mass, grip strength, calcium intake and physical activity, but OC users were slightly older than controls (21.3±1.9 years vs 20.3±1.6 years, P<0.05). In analysis of covariance, controlled for age and BMI, controls had significantly greater BMD than OC users at the AP and lateral spine, femoral neck, greater trochanter, total hip, and whole body (P<0.05). We conclude that, in this cross-sectional analysis, oral contraceptive use by young women may compromise bone health during a time when mineral is still accruing.

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References

  1. NIH consensus P (2001) Osteoporosis prevention, diagnosis, and therapy. JAMA 285:785–795

    PubMed  Google Scholar 

  2. Recker RR, Davies KM, Hinders SM, Heaney RP, Stegman MR, Kimmel DB (1992) Bone gain in young adult women. JAMA 268:2403–2408

    CAS  PubMed  Google Scholar 

  3. Theintz G, Buchs B, Rizzoli R, Slosman D, Clavien H, Sizonenko PC, Bonjour JP (1992) Longitudinal monitoring of bone mass accumulation in healthy adolescents: evidence for a marked reduction after 16 years of age at the levels of lumbar spine and femoral neck in female subjects. J Clin Endocrinol Metab 75:1060–1065

    Google Scholar 

  4. Mosher WD, Deang LP, Bramlett MD (2003) Community environment and women’s health outcomes: contextual data. Vital Health Stat 23:1–72

    Google Scholar 

  5. Drinkwater BL, Nilson K, Chesnut CH 3rd, Bremner WJ, Shainholtz S, Southworth MB (1984) Bone mineral content of amenorrheic and eumenorrheic athletes. N Engl J Med 311:277–281

    CAS  PubMed  Google Scholar 

  6. Johnston CC Jr, Hui SL, Witt RM, Appledorn R, Baker RS, Longcope C (1985) Early menopausal changes in bone mass and sex steroids. J Clin Endocrinol Metab 61:905–911

    Google Scholar 

  7. Ohta H, Ikeda T, Masuzawa T, Makita K, Suda Y, Nozawa S (1993) Differences in axial bone mineral density, serum levels of sex steroids, and bone metabolism between postmenopausal and age- and body size-matched premenopausal subjects. Bone 14:111–116

    CAS  PubMed  Google Scholar 

  8. Rencken ML, Chesnut CH 3rd, Drinkwater BL (1996) Bone density at multiple skeletal sites in amenorrheic athletes. JAMA 276:238–240

    CAS  PubMed  Google Scholar 

  9. Hergenroeder AC, Smith EO, Shypailo R, Jones LA, Klish WJ, Ellis K (1997) Bone mineral changes in young women with hypothalamic amenorrhea treated with oral contraceptives, medroxyprogesterone, or placebo over 12 months. Am J Obstet Gynecol 176:1017–1025

    CAS  PubMed  Google Scholar 

  10. Seeman E, Szmukler GI, Formica C, Tsalamandris C, Mestrovic R (1992) Osteoporosis in anorexia nervosa: the influence of peak bone density, bone loss, oral contraceptive use, and exercise. J Bone Miner Res 7:1467–1474

    CAS  PubMed  Google Scholar 

  11. Grinspoon S, Thomas L, Miller K, Herzog D, Klibanski A (2002) Effects of recombinant human IGF-I and oral contraceptive administration on bone density in anorexia nervosa. J Clin Endocrinol Metab 87:2883–2891

    Google Scholar 

  12. Golden NH, Lanzkowsky L, Schebendach J, Palestro CJ, Jacobson MS, Shenker IR (2002) The effect of estrogen–progestin treatment on bone mineral density in anorexia nervosa. J Pediatr Adolesc Gynecol 15:135–143

    PubMed  Google Scholar 

  13. Kleerekoper M, Brienza RS, Schultz LR, Johnson CC (1991) Oral contraceptive use may protect against low bone mass. Henry Ford Hospital Osteoporosis Cooperative Research Group. Arch Intern Med 151:1971–1976

    CAS  PubMed  Google Scholar 

  14. Kritz-Silverstein D, Barrett-Connor E (1993) Bone mineral density in postmenopausal women as determined by prior oral contraceptive use. Am J Public Health 83:100–102

    CAS  PubMed  Google Scholar 

  15. Masaryk P, Lunt M, Benevolenskaya L, Cannata J, Dequeker J, Dohenhof C, Falch JA, Felsenberg D, Pols HA, Poor G, Reid DM, Scheidt-Nave C, Weber K, O’Neill T, Silman AJ, Reeve J (1998) Effects of menstrual history and use of medications on bone mineral density: the EVOS study. Calcif Tissue Int 63:271–276

    CAS  PubMed  Google Scholar 

  16. Grainge MJ, Coupland CA, Cliffe SJ, Chilvers CE, Hosking DJ (2001) Reproductive, menstrual and menopausal factors: which are associated with bone mineral density in early postmenopausal women? Osteoporos Int 12:777–787

    CAS  PubMed  Google Scholar 

  17. Lindsay R, Tohme J, Kanders B (1986) The effect of oral contraceptive use on vertebral bone mass in pre- and post-menopausal women. Contraception 34:333–340

    CAS  PubMed  Google Scholar 

  18. Tuppurainen M, Kroger H, Saarikoski S, Honkanen R, Alhava E (1994) The effect of previous oral contraceptive use on bone mineral density in perimenopausal women. Osteoporos Int 4:93–98

    CAS  PubMed  Google Scholar 

  19. Gambacciani M, Spinetti A, Cappagli B, Taponeco F, Maffei S, Piaggesi L, Fruzzetti F, Fioretti P (1994) Hormone replacement therapy in perimenopausal women with a low dose oral contraceptive preparation: effects on bone mineral density and metabolism. Maturitas 19:125–131

    CAS  PubMed  Google Scholar 

  20. Gambacciani M, Spinetti A, Taponeco F, Cappagli B, Piaggesi L, Fioretti P (1994) Longitudinal evaluation of perimenopausal vertebral bone loss: effects of a low-dose oral contraceptive preparation on bone mineral density and metabolism. Obstet Gynecol 83:392–396

    CAS  PubMed  Google Scholar 

  21. Volpe A, Malmusi S, Zanni AL, Landi S, Cagnacci A (1997) Oral contraceptives and bone metabolism. Eur J Contracept Reprod Health Care 2:225–228

    CAS  PubMed  Google Scholar 

  22. Taechakraichana N, Limpaphayom K, Ninlagarn T, Panyakhamlerd K, Chaikittisilpa S, Dusitsin N (2000) A randomized trial of oral contraceptive and hormone replacement therapy on bone mineral density and coronary heart disease risk factors in postmenopausal women. Obstet Gynecol 95:87–94

    CAS  PubMed  Google Scholar 

  23. Taechakraichana N, Jaisamrarn U, Panyakhamlerd K, Chaikittisilpa S, Limpaphayom K (2001) Difference in bone acquisition among hormonally treated postmenopausal women with normal and low bone mass. J Med Assoc Thai 84 [Suppl 2]:S586–S592

    Google Scholar 

  24. Weaver CM, Teegarden D, Lyle RM, McCabe GP, McCabe LD, Proulx W, Kern M, Sedlock D, Anderson DD, Hillberry BM, Peacock M, Johnston CC (2001) Impact of exercise on bone health and contraindication of oral contraceptive use in young women. Med Sci Sports Exerc 33:873–880

    CAS  PubMed  Google Scholar 

  25. Burr DB, Yoshikawa T, Teegarden D, Lyle R, McCabe G, McCabe LD, Weaver CM (2000) Exercise and oral contraceptive use suppress the normal age-related increase in bone mass and strength of the femoral neck in women 18–31 years of age. Bone 27:855–863

    CAS  PubMed  Google Scholar 

  26. Polatti F, Perotti F, Filippa N, Gallina D, Nappi RE (1995) Bone mass and long-term monophasic oral contraceptive treatment in young women. Contraception 51:221–224

    CAS  PubMed  Google Scholar 

  27. Lloyd T, Taylor DS, Lin HM, Matthews AE, Eggli DF, Legro RS (2000) Oral contraceptive use by teenage women does not affect peak bone mass: a longitudinal study. Fertil Steril 74:734–738

    CAS  PubMed  Google Scholar 

  28. Berenson AB, Breitkopf CR, Grady JJ, Rickert VI, Thomas A (2004) Effects of hormonal contraception on bone mineral density after 24 months of use. Obstet Gynecol 103:899–906

    CAS  PubMed  Google Scholar 

  29. Nappi C, Di Spiezio Sardo A, Acunzo G, Bifulco G, Tommaselli GA, Guida M, Di Carlo C (2003) Effects of a low-dose and ultra-low-dose combined oral contraceptive use on bone turnover and bone mineral density in young fertile women: a prospective controlled randomized study. Contraception 67:355–359

    CAS  PubMed  Google Scholar 

  30. Elomaa K, Rolland R, Brosens I, Moorrees M, Deprest J, Tuominen J, Lahteenmaki P (1998) Omitting the first oral contraceptive pills of the cycle does not automatically lead to ovulation. Am J Obstet Gynecol 179:41–46

    CAS  PubMed  Google Scholar 

  31. Pereira MA, FitzerGerald SJ, Gregg EW, Joswiak ML, Ryan WJ, Suminski RR, Utter AC, Zmuda JM (1997) A collection of physical activity questionnaires for health-related research. Med Sci Sports Exerc 29:S1–S205

    CAS  PubMed  Google Scholar 

  32. Kohl HW, Blair SN, Paffenbarger RS Jr, Macera CA, Kronenfeld JJ (1988) A mail survey of physical activity habits as related to measured physical fitness. Am J Epidemiol 127:1228–1239

    CAS  PubMed  Google Scholar 

  33. Heyward VH (2002) Advanced fitness assessment and exercise prescription. Human Kinetics, Champaign, IL

  34. Sinaki M, Wahner HW, Offord KP (1989) Relationship between grip strength and related regional bone mineral content. Arch Phys Med Rehabil 70:823–826

    CAS  PubMed  Google Scholar 

  35. Block G (1998) Block 98 Food Frequency Questionnaire. National Cancer Institute, Berkeley

  36. Felson DT, Zhang Y, Hannan MT, Anderson JJ (1993) Effects of weight and body mass index on bone mineral density in men and women: the Framingham study. J Bone Miner Res 8:567–573

    CAS  PubMed  Google Scholar 

  37. Alaimo K, McDowell MA, Briefel RR, Bischof AM, Caughman CR, Loria CM, Johnson CL (1994) Dietary intake of vitamins, minerals, and fiber of persons ages 2 months and over in the United States: Third National Health and Nutrition Examination Survey, phase 1, 1988–91. Adv Data Vital Health Stat Ser 258:1–28

    Google Scholar 

  38. Reed SD, Scholes D, LaCroix AZ, Ichikawa LE, Barlow WE, Ott SM (2003) Longitudinal changes in bone density in relation to oral contraceptive use. Contraception 68:177–182

    CAS  PubMed  Google Scholar 

  39. Prior JC, Kirkland SA, Joseph L, Kreiger N, Murray TM, Hanley DA, Adachi JD, Vigna YM, Berger C, Blondeau L, Jackson SA, Tenenhouse A (2001) Oral contraceptive use and bone mineral density in premenopausal women: cross-sectional, population-based data from the Canadian Multicentre Osteoporosis Study. CMAJ 165:1023–1029

    CAS  PubMed  Google Scholar 

  40. Lloyd T, Buchanan JR, Ursino GR, Myers C, Woodward G, Halbert DR (1989) Long-term oral contraceptive use does not affect trabecular bone density. Am J Obstet Gynecol 160:402–404

    CAS  PubMed  Google Scholar 

  41. Garnero P, Sornay-Rendu E, Delmas PD (1995) Decreased bone turnover in oral contraceptive users. Bone 16:499–503

    CAS  PubMed  Google Scholar 

  42. Pasco JA, Kotowicz MA, Henry MJ, Panahi S, Seeman E, Nicholson GC (2000) Oral contraceptives and bone mineral density: a population-based study. Am J Obstet Gynecol 182:265–269

    CAS  PubMed  Google Scholar 

  43. Mais V, Fruzzetti F, Ajossa S, Paoletti AM, Guerriero S, Melis GB (1993) Bone metabolism in young women taking a monophasic pill containing 20 mcg ethinylestradiol: a prospective study. Contraception 48:445–452

    CAS  PubMed  Google Scholar 

  44. Wasnich RD, Miller PD (2000) Antifracture efficacy of antiresorptive agents are related to changes in bone density. J Clin Endocrinol Metab 85:231–236

    Google Scholar 

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Acknowledgments

This study was funded by the John C. Erkkila Endowment for Health and Human Performance and the Northwest Health Foundation.

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Correspondence to Hawley Almstedt Shoepe.

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Almstedt Shoepe, H., Snow, C.M. Oral contraceptive use in young women is associated with lower bone mineral density than that of controls. Osteoporos Int 16, 1538–1544 (2005). https://doi.org/10.1007/s00198-005-1868-6

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  • DOI: https://doi.org/10.1007/s00198-005-1868-6

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