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

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

Abbey B. Berenson , Tamara Beres Lederer Goldberg , Jerilynn C Prior

Author affiliations (5)
  • The University of Texas Medical Branch at Galveston ROR
  • Universidade Estadual Paulista (Unesp) 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
  • Kaiser Permanente Washington Health Research Institute ROR
DOI10.1111/cen.13932 PMID30614555
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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 12to 24-month BMD change in adolescent (12to 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/cm(2) 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/cm(2) in CHC-exposed adolescents (P = 0.0006). Heterogeneities by I(2) 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 > Contraception Impact > Adolescent Peak BMD AccrualContraception/Comparison > Combined Hormonal > Bone Health EffectsResearch Methodology > Meta-Analysis > Prospective Controlled Studies
Goshtasebi Prior combined hormonal contraception adolescent peak bone mineral density meta-analysis, lumbar spine BMD accrual suppression ethinyl estradiol CHC-exposed teenagers, weighted mean BMD difference -0.02 g/cm2 12-month 24-month prospective data, random-effects model 1535 adolescents 8 paired comparisons spinal bone density, peak bone mass acquisition impairment hormonal contraceptives 12-19 year old women, Centre for Menstrual Cycle Ovulation Research University of British Columbia, heterogeneity I-squared 96% 85% CHC bone density systematic review, DXA dual-energy x-ray absorptiometry lumbar spine measurement adolescent users, supraphysiological ethinyl estradiol dose osteoblast suppression bone formation, public health concern lifetime fracture risk adolescent contraception bone accrual
PMID 30614555 30614555 DOI 10.1111/cen.13932 10.1111/cen.13932

Cite this article

Goshtasebi, A., Subotic Brajic, T., Scholes, D., Beres Lederer Goldberg, T., Berenson, A., & Prior, J. C. (2019). Adolescent use of combined hormonal contraception and peak bone mineral density accrual: A meta-analysis of international prospective controlled studies. *Clinical endocrinology*, *90*(4), 517-524. https://doi.org/10.1111/cen.13932

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