Oral contraceptive use and fracture risk around the menopausal transition

Abstract

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.

Effects of Combination Oral Contraceptives on Bone Mineral Density and Metabolism in Perimenopausal Korean Women

“…Currently, no osteoporosis medicine is approved in premenopausal women. Recent retrospective studies [ 6 21 ] reported that oral contraceptive use did not reduce fracture risk around menopause. Because oral contraceptive use in the late reproductive years has not been popular, the numbers of recent and current users with long-term use was very low in these studies.…”

“…Combination oral contraceptives (COCs) provide highly effective contraception and are used most commonly among women younger than 30 years. COC use in women during later reproductive years is increasing in the U.S. [ 6 ], with improved safety due to decreases in estrogen dose and introduction of newer progestins. In addition to contraception, COCs alleviate climacteric symptoms and might have a positive effect on BMD [ 7 ] Of note, progestin is the dominant component over estrogen in COCs.…”

Does exogenous female sex hormone administration affect the rate of tooth movement and root resorption? A systematic review of animal studies

“…On the contrary, combined oral contraceptives seem to exert a positive effect on bone turnover in adult females [ 63 ]. Overall, there seems to be no association between the risk of fractures in the period before menopause and oral contraceptives use [ 64 ].…”

Depot Medroxyprogesterone Acetate, Oral Contraceptive, Intrauterine Device Use, and Fracture Risk

“…The observed associations between OCP use and fracture were weak and previous studies have not shown a consistent relationship between OCP use and fracture risk. 12,21 Future analyses of our data examining timing of use and estrogen dose may be useful.…”