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

Cibula, David; Skrenková, J; Hill, Martin; Stepan, Jan J.

doi:10.1530/eje-11-1047

Cited by 52 publications

(30 citation statements)

References 37 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Further studies are necessary to determine whether lower doses of ethinyl estradiol may cause lesser increases in SHBG, and therefore cause different impacts on bone. Cibula and colleagues reported lower BMD with the 15‐μg vs. the 30‐μg ethinyl estradiol COC formulation in adolescent girls. Scholes and colleagues found a trend for lower BMD with longer duration of use and lower estradiol dose formulations in young women.…”

Section: Discussionmentioning

confidence: 98%

Effects of Estrogen Replacement on Bone Geometry and Microarchitecture in Adolescent and Young Adult Oligoamenorrheic Athletes: A Randomized Trial

Ackerman

Singhal

Slattery

et al. 2019

Journal of Bone and Mineral Research

View full text Add to dashboard Cite

Oligoamenorrheic athletes (OAs) have lower bone mineral density (BMD) and greater impairment of bone microarchitecture, and therefore higher fracture rates compared to eumenorrheic athletes. Although improvements in areal BMD (aBMD; measured by dual-energy X-ray absorptiometry) in OAs have been demonstrated with transdermal estrogen treatment, effects of such treatment on bone microarchitecture are unknown. Here we explore effects of transdermal versus oral estrogen versus no estrogen on bone microarchitecture in OA. Seventy-five OAs (ages 14 to 25 years) were randomized to (i) a 100-μg 17β-estradiol transdermal patch (PATCH) administered continuously with 200 mg cyclic oral micronized progesterone; (ii) a combined 30 μg ethinyl estradiol and 0.15 mg desogestrel pill (PILL); or (iii) no estrogen/progesterone (NONE) and were followed for 12 months. Calcium (≥1200 mg) and vitamin D (800 IU) supplements were provided to all. Bone microarchitecture was assessed using high-resolution peripheral quantitative CT at the distal tibia and radius at baseline and 1 year. At baseline, randomization groups did not differ by age, body mass index, percent body fat, duration of amenorrhea, vitamin D levels, BMD, or bone microarchitecture measurements. After 1 year of treatment, at the distal tibia there were significantly greater increases in total and trabecular volumetric BMD (vBMD), cortical area and thickness, and trabecular number in the PATCH versus PILL groups. Trabecular area decreased significantly in the PATCH group versus the PILL and NONE groups. Less robust differences between groups were seen at the distal radius, where percent change in cortical area and thickness was significantly greater in the PATCH versus PILL and NONE groups, and changes in cortical vBMD were significantly greater in the PATCH versus PILL groups. In conclusion, in young OAs, bone structural parameters show greater improvement after 1 year of treatment with transdermal 17β-estradiol versus ethinyl estradiol-containing pills, particularly at the tibia.

show abstract

Section: Discussionmentioning

confidence: 98%

Effects of Estrogen Replacement on Bone Geometry and Microarchitecture in Adolescent and Young Adult Oligoamenorrheic Athletes: A Randomized Trial

Ackerman

Singhal

Slattery

et al. 2019

Journal of Bone and Mineral Research

View full text Add to dashboard Cite

show abstract

“…98 In adolescent girls, low-dose oral contraceptives containing less than 30 μg of ethinyl estradiol may interfere with peak bone mass acquisition compared with oral contraceptives containing ≥30 μg of ethinyl estradiol. 99,100 Despite a possible reduction in BMD in oral contraceptive users, a recent Cochrane review of observational studies found no association between oral contraceptive use and increased fracture risk. 101 …”

Section: Secondary Prevention: Assessment Of Populations At Risk For mentioning

confidence: 99%

Optimizing Bone Health in Children and Adolescents

Daniels¹,

Abrams²,

Corkins³

et al. 2014

Pediatrics

393

310

View full text Add to dashboard Cite

The pediatrician plays a major role in helping optimize bone health in children and adolescents. This clinical report reviews normal bone acquisition in infants, children, and adolescents and discusses factors affecting bone health in this age group. Previous recommended daily allowances for calcium and vitamin D are updated, and clinical guidance is provided regarding weight-bearing activities and recommendations for calcium and vitamin D intake and supplementation. Routine calcium supplementation is not recommended for healthy children and adolescents, but increased dietary intake to meet daily requirements is encouraged. The American Academy of Pediatrics endorses the higher recommended dietary allowances for vitamin D advised by the Institute of Medicine and supports testing for vitamin D deficiency in children and adolescents with conditions associated with increased bone fragility. Universal screening for vitamin D deficiency is not routinely recommended in healthy children or in children with dark skin or obesity because there is insufficient evidence of the cost–benefit of such a practice in reducing fracture risk. The preferred test to assess bone health is dual-energy x-ray absorptiometry, but caution is advised when interpreting results in children and adolescents who may not yet have achieved peak bone mass. For analyses, z scores should be used instead of T scores, and corrections should be made for size. Office-based strategies for the pediatrician to optimize bone health are provided. This clinical report has been endorsed by American Bone Health.

show abstract

“…Doses of estrogen less than 30 mg reduce BD accumulation, with the lowest-dose estrogen (15 mg) having the most profound effect (Cibula, Skrenkova, Hill, & Stepan, 2012). This difference is most likely clinically insignificant, because the BD of adolescents taking CHCs is well above the fracture threshold (Gersten, Hsieh, Weiss, & Ricciotti, 2016).…”

Section: Bd Concernsmentioning

confidence: 99%