Elsevier

Contraception

Volume 86, Issue 4, October 2012, Pages 332-336
Contraception

Original research article
Effect of two kinds of different combined oral contraceptives use on bone mineral density in adolescent women

https://doi.org/10.1016/j.contraception.2012.01.009Get rights and content

Abstract

Background

Steroid hormonal contraceptives are highly effective and widely used. Most studies have shown a negative effect of combined oral contraceptives (COCs) on the bone mineral density (BMD) of adolescents. The study was conducted to compare BMD among users of ethinylestradiol/desogestrel, users of ethinylestradiol/cyproterone acetate and nonhormonal control subjects in women aged 16–18 years.

Study Design

The study included 450 women 16–18 years of age. One hundred fifty women were using ethinylestradiol/desogestrel, 150 women were using ethinylestradiol/cyproterone acetate, and 150 women were using nonhormonal contraception as control subjects. BMD ofthe lumbar spine and femoral neck was obtained using dual-energy X-ray absorptiometry, and mean BMD changes in COCs users and nonusers were compared.

Results

At 24 months of treatment, lumbar spine and femoral neck mean BMD values in women (n=127) who used ethinylestradiol/desogestrel were slightly lower compared with baseline, but these effects did not reach statistical significance (p=.837 and p=.630, respectively). The mean lumbar spine and femoral neck BMD values in women (n=134) who used ethinylestradiol/cyproterone acetate were slightly higher compared with baseline, but there was no statistical significance (p=.789 and p=.756, respectively). The increases in mean percent change in lumbar spine and femoral neck BMD in the ethinylestradiol/cyproterone acetate group were less than those in the control group (1.88% vs. 0.30% and 0.98% vs. 0.49%, respectively). There were no significant differences in mean BMD of the lumbar spine and femoral neck between the users of ethinylestradiol/desogestrel or ethinylestradiol/cyproterone acetate and nonusers (p>.05).

Conclusion

Our study indicates that 2 years of COCs therapy had no significant effect on bone density in adolescents, but it remains unknown whether therapy longer than 2 years has a significant adverse effect on the attainment of peak bone mass.

Introduction

Steroid hormonal contraceptives, including oral and injectable contraceptives, are highly effective and widely used. These contraceptives have important health benefits, including contraceptive and noncontraceptive benefits, but also have some health risks, such as bone health. Some studies have demonstrated that use of progestin-only contraceptive depot medroxyprogesterone acetate (DMPA) may cause bone loss [1], [2]. Combined oral contraceptives (COCs) may also adversely affect bone health, especially when used in adolescents [3] and young women [4]. Use of COCs may impede attainment of peak bone mass [4]. Most COCs users are under 30 years of age [5]. Previous investigations have examined the effect of COCs on bone mineral density (BMD) in adolescents [3], [4], [5], [6], [7], [8], [9], but the results are inconsistent.

The objective of the present study was to evaluate whether use of ethinylestradiol (EE)/desogestrel and EE/cyproterone acetate affects bone health in adolescent women by comparing their BMDs with those of controls.

Section snippets

Subjects

We originally enrolled 450 women from 16 to 18 years old attending family planning clinics and requesting birth control. All of these women had never used hormonal contraception prior to recruitment to this study. Three hundred women requesting COCs contraception were randomized into two treatment groups by drawing lots, receiving either an EE/desogestrel oral contraceptive with EE 30 mcg and desogestrel 0.15 mg (N.V. Organon, the Netherlands) (group A, n=150) or EE/cyproterone acetate oral

Demographic and anthropometric characteristics

In total, 450 women aged 16–18 years were recruited. A total of 138 (92.0%) EE/desogestrel users, 139 (92.7%) EE/cyproterone acetate users and 136 (90.7%) nonhormonal users completed the first 12 months of observation, and a total of 127 (84.7%) women in the EE/desogestrel group, 134 (89.3%) women in EE/cyproterone acetate group and 115 (76.7%) women in the nonhormonal group completed the entire 24 months of observation. The reasons for treatment-phase withdrawal (n=23) in group A were as

Discussion

Osteoporosis is characterized by low BMD, compromised architectural stability and increased risk of fracture. Attainment of peak bone mass is essential for the prevention of osteoporosis. Adolescence is the critical period for bone mass accrual. Maximizing peak bone mass in the adolescent period may reduce the risk of osteoporotic fractures in later life. There is no agreement on whether the use of COCs during the adolescent ages has any effect on BMD.

Our study indicated that, at 24 months of

Acknowledgment

We thank Xiaoruo Gai, University of Michigan, USA, for data analysis and assistance in manuscript revision.

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This study was supported by a grant from the Research Foundation of the Shandong Provincial Committee of Family Planning Research, Jinan, Shandong, China.

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