Adolescent use of combined hormonal contraception and peak bone mineral density  accrual: A meta-analysis of international prospective controlled studies

Azita Goshtasebi; Tatjana Subotic Brajic; Delia Scholes; Tamara Beres Lederer Goldberg; Abbey Berenson; Jerilynn C Prior

doi:10.1111/cen.13932

Bone Health Bone Mineral Density

Adolescent use of combined hormonal contraception and peak bone mineral density accrual: A meta-analysis of international prospective controlled studies

Goshtasebi A, Subotic Brajic T, Scholes D, Beres Lederer Goldberg T, Berenson A, Prior JC

Published April 2019 Clinical Endocrinology, 90(4), 517-524

DOI 10.1111/cen.13932 PMID 30614555 PMC PMC6850432

RRM Academy Synopsis

Combined Hormonal Contraception Linked to Less Teen Spine Bone Gain

In adolescents, combined hormonal contraceptive use was linked to less lumbar spine bone gain. A meta-analysis of prospective studies compared users with nonusers. It found a pooled gap of −0.02 g/cm2 at 24 months in 885 adolescents. The 12-month analysis of 1535 adolescents found the same gap.

Key Findings

Searches found 84 publications, and nine were eligible. Eight fed the 12-month analysis and five fed the 24-month analysis.
At 24 months, five paired comparisons in 885 adolescents gave a weighted mean lumbar spine BMD difference of −0.02 g/cm2 for CHC users. The authors call it highly statistically significant.
At 12 months, eight paired comparisons in 1535 adolescents gave a weighted mean lumbar spine BMD difference of −0.02 g/cm2 for CHC users (P = 0.04; 95% CI: −0.05 to 0.00).
Heterogeneity by I2 was 96% at 12 months and 85% at 24 months. Dropping one or more 12-month studies made that result nonsignificant. The 24-month result held when each study was dropped.
Femoral neck, total hip and whole body data were too sparse to pool. The authors described them study by study.

Interpretation

A meta-analysis combines results from separate studies. The authors combined prospective studies of healthy teens, ages 12 to 19, who started combined hormonal contraceptives, and compared them with similar teens who did not. They call for a randomized placebo-controlled trial. The findings support larger studies of how combined hormonal contraception affects bone growth in teens.

RRM Context

Restorative reproductive medicine counts combined hormonal contraceptives as suppressive medications that override the menstrual cycle. The authors list cycle and ovulation problems as factors in peak bone density. They add that teens are increasingly prescribed these drugs for cramps, acne and irregular cycles. Cause-based care asks what lies behind such symptoms.

Our editorial summary of this paper, not the article's abstract.

Abstract

Objective

Many women use combined hormonal contraceptives (CHC) during adolescence during which they are accruing peak areal bone mineral density (BMD) that relates to lifetime fracture risk. To build BMD requires formation with which CHC-related exogenous oestrogen may interfere. We compared peak BMD accrual in adolescents using and not using CHC.

Design/Participants

We performed literature searches for prospective published peer-reviewed articles providing 12- to 24-month BMD change in adolescent (12- to 19-year-old) women using CHC vs CHC-unexposed control women.

Methods

Meta-analyses used random-effects models to assess BMD change rate at lumbar spine (LS) and other sites in adolescent CHC users vs CHC nonusers.

Results

Literature searches yielded 84 publications of which nine were eligible. Adolescent-only data were sought from cohorts with wider age inclusions. The 12-month LS meta-analysis with eight paired comparisons in 1535 adolescents showed a weighted mean BMD difference of -0.02 (95% confidence interval [CI]: -0.05 to 0.00) g/cm2 in CHC-exposed adolescents (P = 0.04). The 24-month LS meta-analysis with five paired comparisons in 885 adolescents showed a highly significant weighted mean BMD difference of -0.02 (95% CI: -0.03 to -0.01) g/cm2 in CHC-exposed adolescents (P = 0.0006). Heterogeneities by I2 were 96% and 85%, respectively. Insufficient data for other bone sites precluded quantitative analysis.

Conclusion

Given that adolescent exposure to CHC appears to be increasing, this evidence for potential impairment of peak spinal BMD accrual is of concern and suggests a potential public health problem. Randomized controlled trial data are needed to determine CHC effects on adolescent bone health.

Topics

Bone Health › Bone Mineral Density › Peak Bone Mass · Contraception › Oral Contraceptives › Metabolic Effects · Therapeutics › Hormonal Agents › Estrogen Preparations

Azita Goshtasebi, Tatjana Subotic Brajic, Delia Scholes, Tamara Beres Lederer Goldberg, Abbey Berenson, Jerilynn C Prior

A Goshtasebi, T Brajic, D Scholes, T Goldberg, A Berenson, J Prior

PMID 30614555 30614555 DOI 10.1111/cen.13932 10.1111/cen.13932 Goshtasebi et al. 2019, Goshtasebi 2019