Age at first oral contraceptive use as a major determinant of vertebral bone mass in female endurance athletes

Hartard, Manfred; Kleinmond, Christine; Kirchbichler, Alexander; Jeschke, D.; Wiseman, Michael; Weissenbacher, E. R.; Felsenberg, Dieter; Erben, Reinhold G.

doi:10.1016/j.bone.2004.05.017

Cited by 46 publications

(23 citation statements)

References 23 publications

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“…This study confirmed that early age at initiation of COC use may be an important risk factor for low peak bone mass in young women (34). In this study, smoking further exacerbated the negative effect of COC on BMD, confirming that smoking is another major determinant of the development of vertebral bone mass (35,36).…”

Section: Discussionsupporting

confidence: 75%

Low-dose estrogen combined oral contraceptives may negatively influence physiological bone mineral density acquisition during adolescence

Cibula

Skrenková

Hill

et al. 2012

European Journal of Endocrinology

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Background: The aim was to evaluate changes of bone mineral density (BMD) and markers of bone turnover in healthy adolescents, and in adolescent users of combined oral contraceptives (COCs) with different ethinylestradiol (EE) contents. Methods: In this prospective crossover study, 56 healthy females (15-19.5 years) with desire to use hormonal contraception were randomized to COC with either 30 or 15 mg of EE in crossover design of 9-month intervention each in reverse order. Nonusers of the same age (nZ28) served as controls. BMD at lumbar spine (LS), total femur, femoral neck, distal radius, and total body, and serum markers (N-propeptide of type I procollagen, and type I collagen C-telopeptide) were measured at baseline and after 9 and 18 months. Results: In COC nonusers, BMD significantly increased at LS and radius, while markers decreased. In COC users, BMD did not increase, with the exception of LS BMD in the 30 mg COC group (P!0.05). In the crossover design, a difference between the low-and very low-dose COC users was found in LS BMD changes (P!0.05), where increase in BMD was more impaired in the 15 mg COC users. The skeletal effects of COC remained significant after adjustments for age and smoking status. Markers declined faster in COC users during the first period, while they remained stable or even increased during the second 9 months. Conclusion: Physiological acquisition of LS BMD during adolescent age may be prevented by use of COC, especially those containing very low dose of EE.

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Section: Discussionsupporting

confidence: 75%

Low-dose estrogen combined oral contraceptives may negatively influence physiological bone mineral density acquisition during adolescence

Cibula

Skrenková

Hill

et al. 2012

European Journal of Endocrinology

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“…In a prospective study enrolling 46,000 women during 482,083 person-yr of follow-up, a higher risk of bone fracture was observed among women who had used OC compared with those who had never used OC (10). Furthermore, low age at initiation of OC use in a group of eumenorrheic female endurance athletes was a major determinant of lower BMD (23). Together with the present data, this indicates that exposure to OC may inhibit the anabolic effect of exercise on bone formation in young women, which is further supported by animal studies (9).…”

Section: Effects On Bone Collagen Turnoversupporting

confidence: 82%

“…The effect of estrogen administration on bone mass in premenopausal women is not clear (6,42). However, when studying young eumenorrheic women, several recent reports have shown a detrimental effect of OC on BMD, especially when combined with exercise (23,61). Findings indicate that OC reduced the ability to achieve a high maximal peak bone mass in young women and may increase the risk of fractures (6,42).…”

Section: Effects On Bone Collagen Turnovermentioning

confidence: 99%

Effect of administration of oral contraceptives in vivo on collagen synthesis in tendon and muscle connective tissue in young women

Hansen

Miller²,

Holm³

et al. 2009

Journal of Applied Physiology

103

104

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M, Langberg H. Effect of administration of oral contraceptives in vivo on collagen synthesis in tendon and muscle connective tissue in young women. J Appl Physiol 106: 1435-1443, 2009. First published October 9, 2008 doi:10.1152/japplphysiol.90933.2008Women are at greater risk than men for certain kinds of diseases and injuries, which may at least partly be caused by sex hormonal differences. We aimed to test the influence of estradiol in vivo on collagen synthesis in tendon, bone, and muscle. Two groups of young, healthy women similar in age, body composition, and exercisetraining status were included. The two groups were either habitual users of oral contraceptives exposed to a high concentration of synthetic estradiol and progestogens (OC, n ϭ 11), or non-OC-users tested in the follicular phase of the menstrual cycle characterized by low concentrations of estradiol and progesterone (control, n ϭ 12). Subjects performed 1 h of one-legged kicking exercise. The next day collagen fractional synthesis rates (FSR) in tendon and muscle connective tissue were measured after a flooding dose of [ 13 C]proline followed by biopsies from the patellar tendon and vastus lateralis in both legs. Simultaneously, microdialysis catheters were inserted in vastus lateralis and in front of the patellar tendon for measurement of insulin-like growth factor I (IGF-I) and its binding proteins. Serum NH 2-terminal propeptide of type I collagen (PINP) and urine COOHterminal telopeptides of type-I collagen (CTX-I) were measured as markers for bone synthesis and breakdown, respectively. Tendon FSR and PINP were lower in OC compared with control. An increase in muscle collagen FSR postexercise was only observed in control (P Ͻ 0.05). Furthermore, the results indicate a lower bioavailability of IGF-I in OC. In conclusion, synthetic female sex hormones administered as OC had an inhibiting effect on collagen synthesis in tendon, bone, and muscle connective tissue, which may be related to a lower bioavailability of IGF-I. estrogen; exercise; insulin-like growth factor I; ethinyl estradiol; bone COLLAGEN is the most abundant protein in the human body and comprises a very high fraction of the tissue organic mass in bone (90%), tendon (60 -85%), ligament (70%), and intramuscular connective tissue (ϳ30% and up to 90%) (31, 57). The frequency of several diseases linked to collagen-rich tissue seems to be biased by sex (30,34,36,65). Furthermore, women are at a greater risk than men for sustaining certain kinds of soft tissue sports injuries (7, 24, 26). Several epidemiological studies have shown that women have up to six times greater risk of anterior cruciate ligament (ACL) ruptures than activity-matched men (24). It has been suggested that sex hormones may influence collagen turnover, tissue composition, and biomechanical properties of the tissues, which in part may explain sex-specific differences in risk (24). In support of this, tendon collagen synthesis is lower in women compared with men at rest and after exercise (47). In addition, a lower p...

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“…104 The definition of OC exposure also differed greatly in the cohort and cross sectional studies. Some used the ''non-user'' v ''user'' distinction, 18 61 -yet these time periods seemed arbitrary, as no reasons for their selection were given. Cobb et al 24 have suggested the concept of ''cumulative oestrogen exposure'' as a quantitative method of defining OC exposure, derived by multiplying the oestrogen dose per month by the total number of months that OCs were used.…”

Section: Discussionmentioning

confidence: 99%

“…Ten (three cohort, [16][17][18] seven cross sectional [19][20][21][22][23][24][25] ) showed a positive effect, 29 (four RCTs, [26][27][28][29] nine cohort, 30-38 15 cross sectional, [39][40][41][42][43][44][45][46][47][48][49][50][51][52][53] one case series 54 ) showed no effect, and seven (four cohort, [55][56][57][58] three cross sectional [59][60][61] ) showed a negative effect. All of the RCTs showed no effect on BMD, as measured by either dual energy x ray absorptiometry (DXA) 26 27 29 or quantitative computed tomography.…”

Section: Healthy Premenopausal Womenmentioning

confidence: 99%

Effect of oral contraceptives and hormone replacement therapy on bone mineral density in premenopausal and perimenopausal women: a systematic review

2005

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Seventy five articles on the effect of oral contraceptives and other hormone replacement on bone density in premenopausal and perimenopausal women were reviewed. The evidence was appraised using the Oxford Centre for Evidence-Based Medicine levels of evidence. There is good evidence for a positive effect of oral contraceptives on bone density in perimenopausal women, and fair evidence for a positive effect in ''hypothalamic'' oligo/amenorrhoeic premenopausal women. There is limited evidence for a positive effect in healthy and anorexic premenopausal women. In hypothalamic oligo/ amenorrhoeic women, baseline bone density has been shown to be significantly lower than that in healthy controls, therefore the decision to treat is clinically more important. The ideal formulation(s) and duration of treatment remain to be determined by further longitudinal and prospective randomised controlled trials in larger subject populations.

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Age at first oral contraceptive use as a major determinant of vertebral bone mass in female endurance athletes

Cited by 46 publications

References 23 publications

Low-dose estrogen combined oral contraceptives may negatively influence physiological bone mineral density acquisition during adolescence

Low-dose estrogen combined oral contraceptives may negatively influence physiological bone mineral density acquisition during adolescence

Effect of administration of oral contraceptives in vivo on collagen synthesis in tendon and muscle connective tissue in young women

Effect of oral contraceptives and hormone replacement therapy on bone mineral density in premenopausal and perimenopausal women: a systematic review

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