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. 2020 Jul;38(4):544-554.
doi: 10.1007/s00774-019-01081-1. Epub 2020 Jan 25.

Oral contraceptive use, bone mineral density, and bone turnover markers over 12 months in college-aged females

Hawley C Almstedt  1 , Makenzie M Cook  2 , Lily F Bramble  2 , Deepa V Dabir  3 , Joseph W LaBrie  4
Affiliations

Oral contraceptive use, bone mineral density, and bone turnover markers over 12 months in college-aged females

Hawley C Almstedt et al. J Bone Miner Metab. 2020 Jul.

Abstract

Introduction: The purpose of this study was to compare bone mineral density (BMD) and bone turnover markers between combined oral contraceptive (COC) and non-COC users over 12 months.

Materials and methods: COC users (n = 34, age = 19.2 ± 0.5) and non-COC users (n = 28, age = 19.3 ± 0.6) provided serum at baseline, 6 months, and 12 months. C-terminal telopepetides (CTX) and pro-collagen type 1 N-terminal propeptides (P1NP) were determined using ELISA. BMD was measured at the three time points using dual-energy x-ray absorptiometry (DXA).

Results: COC users had greater CTX than non-COC users at baseline (18.6 ± 8.2 vs. 13.8 ± 5.3 ng/mL, P = 0.021) and 6 months (20.4 ± 10.3 vs. 14.2 ± 8.5 ng/mL, P = 0.018). Controlling for lean mass, groups were similar in BMD. Over 12 months, non-COC users maintained BMD at the spine, while the COC users declined 2.2% in lateral spine BMD (0.773 ± 0.014 to 0.756 ± 0.014 g/cm2, P = 0.03) and 0.7% in anterior-posterior spine BMD (1.005 ± 0.015 to 0.998 ± 0.015 g/cm2, P = 0.069). Non-COC users increased in BMD of the whole body over 12 months (P < 0.001) while COC users had no change. Women who began COCs within 4 years after menarche had lower BMD at the hip and whole body. Women taking very low dose COCs (20 mcg ethinyl estradiol, EE) significantly declined in CTX, P1NP, and lateral spine BMD in comparison to participants using low dose COCs (30/35 mcg EE).

Conclusion: College-aged women who did not use COCs increased BMD of the whole body, while COC users had elevated bone turnover, declines in spinal BMD, and lack of bone acquisition of the whole body over 12 months. Young females who initiate COC use early after menarche may experience skeletal detriments.

Keywords: CTX; Menarche; P1NP; Peak bone mass; Premenopausal.

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Conflict of interest statement

Compliance with ethical standards

Conflict of interest All authors have no conflicts of interest.

Figures

Fig. 1
Fig. 1
Resorption bone turnover marker in combined oral contraceptive (COC) users and non-COC users. Data are presented for study entry (0 months), 6, and 12 months in young females. CTX is C-terminal telopeptides. COC users have significantly greater CTX at study entry (*P = 0.02) and 6 months (#P = 0.018) compared to non-COC users
Fig. 2
Fig. 2
Formation bone turnover marker in combined oral contraceptive (COC) users and non-COC users. Data are presented for study entry (0 months), 6, and 12 months in young females. P1NP is procollagen type 1 N-terminal propeptides
Fig. 3
Fig. 3
Bone mineral density (BMD) at the lateral spine in combined oral contraceptive (COC) users and non-COC users. Data are presented for study entry (0 months), 6, and 12 months. COC users show a significant decline in BMD from study entry to 12 months, *P = 0.005
Fig. 4
Fig. 4
Bone mineral density (BMD) at the anterior–posterior (AP) spine in combined oral contraceptive (COC) users and non-COC users. Data are presented for study entry (0 months), 6, and 12 months. COC users have a declining trend in BMD from 6- to 12-month measurements, *P = 0.069
Fig. 5
Fig. 5
Bone mineral density (BMD) of the whole body in combined oral contraceptive (COC) users and non-COC users. Data are presented for study entry (0 months), 6, and 12 months. Non-COC users show a significant increase in BMD from study entry to 12 months, *P < 0.001
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