A randomized trial of oral contraceptive and hormone replacement therapy on bone mineral density and coronary heart disease risk factors in postmenopausal women

Taechakraichana, Nimit; Limpaphayom, K; Ninlagarn, T; Panyakhamlerd, Krasean; Chaikittisilpa, Sukanya; Dusitsin, Nikorn

doi:10.1016/s0029-7844(99)00493-7

Cited by 21 publications

(10 citation statements)

References 24 publications

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“…24-26 Other trials of peri-menopausal women aged 40-60 years that used 20 or 30 mcg EE OCs vs. placebo or hormone therapy comparison groups also reported significantly increased BMD with OC use during 1- to 3-year follow-ups. 44,45 Investigation of hormone and BMD trajectories following OC discontinuation at these peri-menopausal ages would be informative.…”

Section: Discussionmentioning

confidence: 99%

Oral contraceptive use and fracture risk around the menopausal transition

et al. 2016

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Objective The effect of oral contraceptive (OC) use on risk of fracture remains unclear, and use during later reproductive life may be increasing. To determine the association between oral contraceptive (OC) use during later reproductive life and risk of fracture across the menopausal transition, we conducted a population-based case-control study in a Pacific Northwest HMO, Group Health Cooperative. Methods For the January 2008-March 2013 interval, 1,204 case women aged 45-59 years with incident fractures and 2,275 control women were enrolled. Potential cases with fracture codes in automated data were adjudicated by EHR review. Potential control women without fracture codes were selected concurrently, sampling on age. Participants received a structured study interview. Using logistic regression, associations between OC use and fracture risk were calculated as odds ratios (OR) and 95% confidence intervals (CI). Results Participation was 69% for cases and 64% for controls. The study sample was 82% white; mean age was 54 years. The most common fracture site for cases was the wrist/forearm (32%). Adjusted fracture risk did not differ between cases vs. controls for OC use in the 10 years before menopause (OR=0.90, 95% CI 0.74,1.11); for OC use after age 38 (OR=0.94, 95% CI 0.78,1.14); for duration of use, or for other OC exposures. Conclusions The current study does not show an association between fractures near the menopausal transition and OC use in the decade before menopause or after age 38. For women considering oral contraceptive use at these times, fracture risk does not appear to be either reduced or—reassuringly—increased.

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Section: Discussionmentioning

confidence: 99%

Oral contraceptive use and fracture risk around the menopausal transition

et al. 2016

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“…. Medrogestone 5 mg/day for 10 days per cycle together with 0.625 mg CEE/day for 21 days per cycle [48] were compared with a COC containing 30 mg EE/day plus 150 mg desogestrel/day. .…”

Section: Studies With Hormone Replacement Therapy In Postmenopausal Wmentioning

confidence: 99%

Long-term effects of progestins on bone quality and fractures

Thijssen

2007

Gynecological Endocrinology

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The effects of progestins on the quality of bone and their influence on the risk of fractures are reviewed. Data discussed are based on experimental studies in vivo that generally lasted for longer than one year. Information is given on the background of osteoporosis and on several means of inducing changes in bone quality. In young women who start using oral contraceptives based on progestins alone shortly after pubertal development, a significant decrease in bone quality has been documented. World Health Organization experts have concluded that this is not a real argument for restrictions on the use of these contraceptives. In postmenopausal women, no evidence has been found for a bone-protective or an estrogen-antagonistic effect of progestins. A wide range of estrogens have been used that have shown positive effects on bone, which are not antagonized by progestins. The therapeutic use of high-dose megestrol acetate may result in marked negative effects on bone, leading to severe osteoporosis, possibly due to the inherent glucocorticoid activity of this progestin. Other pharmacotherapeutic agents that can be used in postmenopausal therapy, and that clearly have beneficial effects on bone, are discussed.

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“…It is estimated that half of all postmenopausal women will have an osteoporosis related fracture during their lives, including 25% who will develop a vertebral deformity, and 15% who will suffer a hip fracture (Nelson, Rizzo et al 2002). In addition to the great deal of research on HRT as an effective method of preventing or retarding this loss of bone (Kritz-Silverstein and Barrett-Connor 1993; Gambacciani, Ciaponi et al 2000;Taechakraichana, Limpaphayom et al 2000), there are many studies exploring the implications of OC treatment in postmenopausal women (Kaunitz 2001). …”

Section: Effects Of Oral Contraceptive Use On Bonementioning

confidence: 99%

“…Administration of both hormone replacement therapy and OCs have been shown to increase BMD of the lumbar spine and hip in this age group over a period of 12 months (Taechakraichana, Limpaphayom et al 2000). However, it is less clear whether exogenous estrogens administered as OCs can modify premenopausal BMD .…”

Section: Effects Of Oral Contraceptive Use On Bonementioning

confidence: 99%

“…Therefore, one might assume that a reduced state of bone turnover in this age group may interfere with normal age-related bone growth. In postmenopausal women, use of OCs has led to suppression of bone turnover, and increased BMD in various sites including the lumbar spine (Taechakraichana, Limpaphayom et al 2000), hip Taechakraichana, Limpaphayom et al 2000), and femoral neck .…”

Section: Introductionmentioning

confidence: 99%

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Influence of Oral Contraceptives on Bone Adaptations to Isokinetic Strength Training in Young Women

Selmon

Herbert

Nickols‐Richardson

et al. 2004

Medicine & Science in Sports & Exercise

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Osteoporosis is a debilitating and costly disease of the skeleton characterized by low bone mass and structural deterioration of bone tissue leading to bone fragility and an increased susceptibility to fractures of the hip, spine, and wrist. Current data suggest that at present time, 7.8 and 21.8 million women have osteoporosis and osteopenia respectively. The development of osteoporosis and related fracture in later life depends not only on the rate of bone loss in adulthood, but also on the amount of bone present at skeletal maturity. Oral contraceptives (OC), because of their capacity to diminish concentrations of free testosterone and estrogen, have been purported to affect bone mass in young adult women, but results have proven inconsistent. Further, positive skeletal effects of exercise training are thought to be compromised by use of OCs in skeletally immature females. PURPOSE: To assess the independent and synergistic effects of OC use on bone mineral density (BMD) and long bone mechanical bending stiffness (EI) in college-aged females after unilateral isokinetic resistance training. METHODS: Forty six females (age 20±1.4 yr, height 163.8±6.2cm, weight 58.9±8.6kg, fat 27.9±4.8%) were categorized as OC users (OC, N=22) or non-users (NOC, N=24). Subjects participated in 32 weeks (3 d/wk) of unilateral arm and leg training at an angular velocity of 60°/s using isokinetic dynamometers. BMD and EI MRTA were assessed using dual-energy x-ray absorptiometry (DXA) and mechanical response tissue analysis (MRTA), respectively. RESULTS: Total leg and arm muscular strength of the trained limb increased by 16% and 15%, respectively (p< 0.001), beyond changes observed in the control limbs. Total body BMD increased from baseline for NOC subjects (p < 0.05), but not for OC users. This difference failed to show significance (p = 0.069) when comparisons were run between NOC and OC groups. Increases in ulnar BMD (p < 0.01 for all limbs) and BMD of the trained total hip (OC, p < 0.001; NOC, p < 0.05) occurred irrespective of contraceptive status. Positive changes in EI were conflicting, occurring in the trained ulna for the NOC group (p < 0.05), and trained tibia for OC users (p < 0.05). Tibial BMD increased only for the untrained leg in NOC subjects (p < 0.01). No between group differences were found to be significant, nor were differences between trained vs. untrained, and weight bearing (tibia) vs. non-weight-bearing (ulna) limbs found to be significant. CONCLUSION: These results suggest that oral contraceptives may limit attainment of total body peak bone mass in young adult females. Skeletal maturation in the ulna appeared to be unaffected by exercise training and OC use. Positive effects of exercise training on the total hip were seen in both groups, irrespective of OC status. Conversely, exercise training and use of OCs use may limit the attainment of bone mass in the tibia. Further studies are needed to determine the interactive effects of OC use and isokinetic resistance training on measures of total body an...

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A randomized trial of oral contraceptive and hormone replacement therapy on bone mineral density and coronary heart disease risk factors in postmenopausal women

Abstract: Both OC and HRT increased bone mineral density of lumbar spine and hip, but OC suppressed bone turnover more than HRT. Both methods favorably affected lipid-lipoprotein metabolism, fasting plasma glucose, and blood pressure during the 12 months of treatment.

Cited by 21 publications

References 24 publications

Oral contraceptive use and fracture risk around the menopausal transition

Oral contraceptive use and fracture risk around the menopausal transition

Long-term effects of progestins on bone quality and fractures

Influence of Oral Contraceptives on Bone Adaptations to Isokinetic Strength Training in Young Women

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