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Teen contraceptive and osteoporosis risk
Title:Effects of contraceptive use on bone biochemical markers in young women
Author: S. Ott, et al.
Address: Seattle, Washington
Source: Journal of Clinical Endocrinology and Metabolism 86:179-185 (January) 2001
Summary: Bone density in young premenopausal women is a main factor in determining osteoporosis risk in elderly women. Because the use of hormonal contraceptives can affect bone density in women during their reproductive years, researchers wanted to compare biochemical markers of bone resorption and formation in young women using different hormonal contraceptive methods. Participants were women ranging in age from 18 to 39 years who were using depot medroxyprogesterone acetate (DMPA) contraception. Controls consisted of women matched by age and clinic location. There were 116 participants using DMPA, 39 using oral contraceptives containing estrogen and progestin, and 72 not currently using hormonal contraceptives.The N-telopeptide levels, adjusted for age and other risk factors, were 42.4 ± 2.3 nmol/mmol creatinine in the DMPA group, 26.2 ± 3.3 nmol/mmol in the oral contraceptive group, and 35.4 ± 2.9 nmol/mmol in the nonusers, which were significant differences in all pairwise comparisons. Osteocalcin levels showed the same pattern, although the difference between those using DMPA and those who were not was not statistically significant. There were no differences among groups in the PTH levels. The bone density at the spine was 1.086 ± 0.085 g/cm2 in the DMPA group, 1.103 ± 0.095 g/cm2 in the oral contraceptive group and 1.093 ± 0.090 g/cm2 in nonusers. Researchers concluded that women who use DMPA contraception have bone resorption rates that are higher than formation rates, with a negative bone balance and decreased bone density. Those women who use OCs have lower bone formation and resorption rates than women not using hormonal contraception.
Comment: In terms of risk of osteoporosis, this and previous studies suggest that OCs are preferable to Depo-Provera. Because of well-demonstrated issues of compliance with oral OCs, it seems highly advantageous to use an injectable contraceptive. Clearly DMPA has been associated with reduced bone density. This fact should be taken into consideration when considering this method.