Abstract
BackgroundLow-dose combined oral contraceptives (COCs) can interfere with bone mass acquisition during adolescence. This study aimed to evaluate bone mineral density (BMD) and bone mineral content (BMC) in female adolescents taking a standard low-dose COC (ethinylestradiol 20 μg/desogestrel 150 μg) over a 1-year period and to compare their data with those of healthy adolescents from the same age group not taking COCs.MethodsThis was a non-randomized parallel-control study with a 1-year follow-up. Sixty-seven adolescents aged from 12 to 19 years, divided into COC users (n = 41) taking 20 μg ethinylestradiol/150 μg desogestrel and COC non-user controls (n = 26), were evaluated by bone densitometry examinations at baseline and after 12 months. Comparisons between the groups at the study onset were performed using the Mann–Whitney test with the significance level fixed at 5% or p < 0.05. Comparisons between the groups at the study onset and after 12 months were based on variations in the median percentages for bone mass variables.ResultsThe COC users presented with low bone mass acquisition in the lumbar spine, and had BMD and BMC median variations of 2.07% and +1.57%, respectively, between the measurements at baseline and 12 months. The control group had median variations of +12.16% and +16.84% for BMD and BMC, respectively, over the same period. The total body BMD and BMC showed similar evolutions during the study in both groups. Statistical significance (p < 0.05) was seen for the BMC percentage variation between COC users and non-users.ConclusionsUse of a low-dose COC (ethinylestradiol 20 μg/desogestrel 150 μg) was associated with lower bone mass acquisition in adolescents during the study period.Trial registrationRegistry Number, RBR-5h9b3c.
Highlights
Low-dose combined oral contraceptives (COCs) can interfere with bone mass acquisition during adolescence
There were no significant differences between the groups for age, bone age (BA), anthropometric variables, and variables obtained by bone densitometry (Table 1) at
We took a different approach to those previously found in the literature, as we studied a group of adolescents rather than young adults, and tried to exclude those factors known to interfere with bone mass acquisition, such as tobacco and alcohol use
Summary
Low-dose combined oral contraceptives (COCs) can interfere with bone mass acquisition during adolescence. Genetic factors are responsible for 60–80% of the bone mass increment [6,7], while the remaining bone mass is achieved through other factors such as adequate calcium intake, sun exposure, adequate dietary and supplemental vitamin D intake, and regular physical activity [8]. Additional factors such as gonadal hormones, estrogen, play crucial roles in bone mass acquisition during adolescence. Experimental studies have shown that estrogen reduces osteoclast formation (osteoclastogenesis) and activity, thereby decreasing bone reabsorption, mainly
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