Original research articleEffect of two kinds of different combined oral contraceptives use on bone mineral density in adolescent women☆
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.