Combined hormonal contraceptives use and bone mineral density changes in  adolescent and young women in a prospective population-based Canada-wide  observational study

Brajic TS, Berger C, Schlammerl K, Macdonald H, Kalyan S, Hanley DA, Adachi JD, Kovacs CS, Prior JC

doi:10.1515/jmni-2018-0038

Journal of Musculoskeletal & Neuronal Interactions, 18(2), 227-236, 2018

Combined hormonal contraceptives use and bone mineral density changes in adolescent and young women in a prospective population-based Canada-wide observational study

Christopher S Kovacs , Claudie Berger , David A Hanley

Author affiliations (6)

Memorial University of Newfoundland, St John’s, NL, Canada ROR
McGill University ROR
McMaster University, Hamilton, ON, Canada ROR
Vancouver Coastal Health ROR
Vancouver Hospital and Health Sciences Centre ROR
Centre for Menstrual Cycle and Ovulation Research, Medicine/Endocrinology, University of British Columbia, Vancouver, B.C., Canada. ROR

DOI10.1515/jmni-2018-0038 PMID29855445

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Abstract

Objectives

To assess combined hormonal contraceptives (CHC) use and adolescent women's peak areal bone mineral density (BMD) accrual.

Methods

We enrolled 527 randomly selected women across Canada (2004-6) divided by age into adolescents (16-19) and young adults (20-24) and by CHC use to ever (E-CHC)/never (N-CHC) users. At baseline and year 2 we measured height, weight, and BMD at lumbar spine (L1-4), femoral neck, and total hip sites. Interviewer-administered questionnaires addressed menarche age, cigarette and alcohol use, calcium/vitamin D intakes, physical activity and estrogen dose (≤30/>30 micrograms). Linear regression models examined associations of CHC use with 2-year BMD change adjusted for bone-related variables.

Results

Of 307 women with complete data, 229 (75%) used CHC. N-CHC adolescents gained significantly more unadjusted total hip BMD +0.012 g/cm(2)/2-y (95% C.I.: 0.001, 0.023) with similar trends at all sites. N-CHC adolescents tended to have greater adjusted femoral neck BMD gain: mean difference +0.009 g/cm(2) (95% CI: -0.002; 0.021). In young women N-CHC, however, adjusted femoral neck BMD decreased significantly more -0.021 g/cm(2) (95%CI: -0.006; -0.036) with similar trends at other sites. BMD changes were unrelated to estrogen dose and age at starting CHC.

Conclusions

Adolescent CHC users in a random population demonstrated less hip region peak BMD accrual than non-users. This requires randomized control trial confirmation.

Topics

Bone Health > Contraception Impact > Population-Based Prospective Evidence Contraception/Comparison > Combined Hormonal > Skeletal Health Outcomes Research Methodology > Prospective Cohort > Canadian Multicentre Study

Brajic Berger Schlammerl CHC use bone mineral density adolescent young women prospective, combined hormonal contraceptive peak BMD accrual 527 Canadian women population-based, lumbar spine femoral neck total hip BMD change CHC users versus nonusers DXA, adolescents 16-19 young adults 20-24 bone density contraceptive pill longitudinal, CaMos study randomized enrollment bone density hormonal contraception Canada, ethinyl estradiol bone formation suppression peak bone mass age-stratified analysis, Journal Musculoskeletal Neuronal Interactions 2018 CHC bone health prospective data, BMD change rate percent per year CHC exposed unexposed premenopausal women, oral contraceptive bone density clinical significance fracture risk young women, population-based prospective Canadian study contraception skeletal health impact

PMID 29855445 29855445 DOI 10.1515/jmni-2018-0038 10.1515/jmni-2018-0038

Cite this article

Brajic, T. S., Berger, C., Schlammerl, K., Macdonald, H., Kalyan, S., Hanley, D. A., Adachi, J. D., Kovacs, C. S., Prior, J. C., & CaMos Research Group (2018). Combined hormonal contraceptives use and bone mineral density changes in adolescent and young women in a prospective population-based Canada-wide observational study. Journal of musculoskeletal & neuronal interactions, 18(2), 227-236. https://doi.org/10.1515/jmni-2018-0038

Keywords

Contraceptives, Oral, Combined

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