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Influence of oral contraceptive use on bone density in climacteric women
Maturitas, 9 (1988) 375-378 Elsevier Scientific Publishers Ireland Ltd.
375
MAT 00452
Short communication
Influence of oral contraceptive use on bone density in climacteric women H. Enzelsberger, M. Metka, G. Heytmanek, B. Schurz, Ch. Kurz and M. Kusztrich 1stDept. Obstetrics and Gynaecoiogy, University of Vienna, Austria (Received 26 June 1987; revision received 27 October 1987; accepted 13 November 1987)
The aim of the study was to investigate the influence of long-term administration of oral contraceptives on bone density in climacteric women. The existence of a correlation between longterm use and bone density was confirmed. (Key words: Bone density, Oral contraception, Climacteric)
Introdaetion As a result of increasing life expectancy, 95% of the female population in developed countries survive the climacteric and 60% live beyond the age of 75 yr. About one-third of all women are in the post-menopause and most of them suffer from physical or psychic distress due to oestrogen deficiency (11. There is no doubt the osteoporosis, which is prevalent in the second half of life, is the most frequent generalized bone disease. Previous studies have concluded that absolute oestrogen deficiency in the peri-menopause, as well as the relative oestrogen deficiency which induces primary and secondary [2]. The clinical amenorrhoea in younger women, may cause osteoporosis diagnosis of osteoporosis is made in cases of spontaneous fracture associated with qualitative or quantitative evidence of reduced bone mass. Recently, post-menopausal osteoporosis has become an area of burgeoning interest in terms of medical, social and economic costs. It is a problem that logically falls within the purview of the gynaecologist.
Correspondence to: Dr. H. Enxelsberger, University Gynaecology, Spitalgasse 23. 1090 Wien. Austria.
of
Vienna,
0378~5122/88/$03.50 0 1988 Elsevier Scientific Publishers Ireland Ltd. Printed and Published in Ireland
1st Dept.
Obstetrics and
376
Subjects and methods Two hundred (200) climacteric women were allocated to three study groups (I, II and III). The first (n = 30) had been using oral contraceptives for more than 10 yr, the second (n = 50) for between 2 and 9 years, while the third (n = 120) had never used oral contraceptives. Bone mineral content (BMC) of the right forearm was measured by single photon absorptiometry, using an ND 1OOOA Bone Density Scanner (Nuclear Data Corporation). This method estimates BMC at proximal and distal sites in the forearm.
TABLE I BONE MINERAL CONTENT (BMC) IN WOMEN WHO HAD USED ORAL CONTRACEPTIVES (OC) FOR OVER 10 yr 30 47.9 f 2.3 (yr) 63.5 f 6.7 (kg) 13.8 f 2.4 (yr)
N: Age: Weight: oc:
Group I
BMC-2/i%
2.0 1.5 1.0 I-
0.5
1
I
30
I
40
I
50
1
60
Luteinizing hormone Follicle-stimulating hormone Proximal Distal Menstruation yes no Normal BMC Pathological BMC
I
70
I
80
age wears)
32.5 f 18.3 41.4 f 20.1 1.52 f 0.14 1.14 f 0.25 10 (33%) 20 (67%) 29 (99vo) 1 (1010)
mIU/ml mIU/ml g/cm2 g/cm2
371
TABLE II BONE MINERAL CONTENT (BMC) IN WOMEN WHO HAD USED ORAL CONTRACEPTIVES (OC) FOR 2-9 yr
Group II
50 50.1 f 2.1 (yr) 60.9 f 3.1 (kg) 3.9 * 1.5 (yr)
&: weight: OC: BMC-2/BW
I
30
I
40
1
50
I
60
Lleinihg hormone Follickdmulating hormone proximal Distal
Menstruation Normal BMC Patho1ogic.d BMC
yes no
I
70
I
80 age (years) 35.2 f 22.3 50.3 f 29.1 1.21 f 0.21 0.85 f 0.26 13 (26%) 37 (74%) 36 (72%) 14 (28%)
mIU/ml mIU/ml g/cm~ g/d
COllClQ8iOll
The results demonstrate that osteoporosis occurs later and is less frequent during the peri-menopause (P < 0.01) in women who have used oraI contraceptives on a long-term basis (> 10 yr). Our findings confii that there is an important correlation between long-term use of oral contraceptives and bone density.
318 TABLE III BONE MINERAL CONTRACEPTIVES
CONTENT (OC)
Croup III
M Age: Weight: oc:
(BMC)
IN
WOMEN
WHO
HAD
NEVER
USED
ORAL
120 48.3 f 4.5 (yr) 63.2 f 5.5 (kg) ----(yr)
BBC-2/BW
30
40
50
60
Lutcinixing hormone Folliclwtimulating hormone PrOXiIUd Distal
Menstruation Normal BMC Pathological BMC
yes no
70
80 age (years)
35.7 f 26.1 46.7 f 27.3 1.31 f 0.16 0.92 f 0.23 24 (20%) 96 (80%) 104 (86Vo) 16 (14”i’o)
mIU/ml mIU/ml g/cm’ g/cm*
References 1 2
Avioli LV. Osteoporosis. In: Peck WA, ed. Bone and mineral research, Annual 1. Amsterdam - Oxford - Princeton: Excerpta Medica, 1983; 280-318. Horsman A, Jones M, Francis R, Nordin C. The effect of estrogen dose on postmenopausal bone loss. N Engl J Med 1983; 309: 1405-1407.
375
MAT 00452
Short communication
Influence of oral contraceptive use on bone density in climacteric women H. Enzelsberger, M. Metka, G. Heytmanek, B. Schurz, Ch. Kurz and M. Kusztrich 1stDept. Obstetrics and Gynaecoiogy, University of Vienna, Austria (Received 26 June 1987; revision received 27 October 1987; accepted 13 November 1987)
The aim of the study was to investigate the influence of long-term administration of oral contraceptives on bone density in climacteric women. The existence of a correlation between longterm use and bone density was confirmed. (Key words: Bone density, Oral contraception, Climacteric)
Introdaetion As a result of increasing life expectancy, 95% of the female population in developed countries survive the climacteric and 60% live beyond the age of 75 yr. About one-third of all women are in the post-menopause and most of them suffer from physical or psychic distress due to oestrogen deficiency (11. There is no doubt the osteoporosis, which is prevalent in the second half of life, is the most frequent generalized bone disease. Previous studies have concluded that absolute oestrogen deficiency in the peri-menopause, as well as the relative oestrogen deficiency which induces primary and secondary [2]. The clinical amenorrhoea in younger women, may cause osteoporosis diagnosis of osteoporosis is made in cases of spontaneous fracture associated with qualitative or quantitative evidence of reduced bone mass. Recently, post-menopausal osteoporosis has become an area of burgeoning interest in terms of medical, social and economic costs. It is a problem that logically falls within the purview of the gynaecologist.
Correspondence to: Dr. H. Enxelsberger, University Gynaecology, Spitalgasse 23. 1090 Wien. Austria.
of
Vienna,
0378~5122/88/$03.50 0 1988 Elsevier Scientific Publishers Ireland Ltd. Printed and Published in Ireland
1st Dept.
Obstetrics and
376
Subjects and methods Two hundred (200) climacteric women were allocated to three study groups (I, II and III). The first (n = 30) had been using oral contraceptives for more than 10 yr, the second (n = 50) for between 2 and 9 years, while the third (n = 120) had never used oral contraceptives. Bone mineral content (BMC) of the right forearm was measured by single photon absorptiometry, using an ND 1OOOA Bone Density Scanner (Nuclear Data Corporation). This method estimates BMC at proximal and distal sites in the forearm.
TABLE I BONE MINERAL CONTENT (BMC) IN WOMEN WHO HAD USED ORAL CONTRACEPTIVES (OC) FOR OVER 10 yr 30 47.9 f 2.3 (yr) 63.5 f 6.7 (kg) 13.8 f 2.4 (yr)
N: Age: Weight: oc:
Group I
BMC-2/i%
2.0 1.5 1.0 I-
0.5
1
I
30
I
40
I
50
1
60
Luteinizing hormone Follicle-stimulating hormone Proximal Distal Menstruation yes no Normal BMC Pathological BMC
I
70
I
80
age wears)
32.5 f 18.3 41.4 f 20.1 1.52 f 0.14 1.14 f 0.25 10 (33%) 20 (67%) 29 (99vo) 1 (1010)
mIU/ml mIU/ml g/cm2 g/cm2
371
TABLE II BONE MINERAL CONTENT (BMC) IN WOMEN WHO HAD USED ORAL CONTRACEPTIVES (OC) FOR 2-9 yr
Group II
50 50.1 f 2.1 (yr) 60.9 f 3.1 (kg) 3.9 * 1.5 (yr)
&: weight: OC: BMC-2/BW
I
30
I
40
1
50
I
60
Lleinihg hormone Follickdmulating hormone proximal Distal
Menstruation Normal BMC Patho1ogic.d BMC
yes no
I
70
I
80 age (years) 35.2 f 22.3 50.3 f 29.1 1.21 f 0.21 0.85 f 0.26 13 (26%) 37 (74%) 36 (72%) 14 (28%)
mIU/ml mIU/ml g/cm~ g/d
COllClQ8iOll
The results demonstrate that osteoporosis occurs later and is less frequent during the peri-menopause (P < 0.01) in women who have used oraI contraceptives on a long-term basis (> 10 yr). Our findings confii that there is an important correlation between long-term use of oral contraceptives and bone density.
318 TABLE III BONE MINERAL CONTRACEPTIVES
CONTENT (OC)
Croup III
M Age: Weight: oc:
(BMC)
IN
WOMEN
WHO
HAD
NEVER
USED
ORAL
120 48.3 f 4.5 (yr) 63.2 f 5.5 (kg) ----(yr)
BBC-2/BW
30
40
50
60
Lutcinixing hormone Folliclwtimulating hormone PrOXiIUd Distal
Menstruation Normal BMC Pathological BMC
yes no
70
80 age (years)
35.7 f 26.1 46.7 f 27.3 1.31 f 0.16 0.92 f 0.23 24 (20%) 96 (80%) 104 (86Vo) 16 (14”i’o)
mIU/ml mIU/ml g/cm’ g/cm*
References 1 2
Avioli LV. Osteoporosis. In: Peck WA, ed. Bone and mineral research, Annual 1. Amsterdam - Oxford - Princeton: Excerpta Medica, 1983; 280-318. Horsman A, Jones M, Francis R, Nordin C. The effect of estrogen dose on postmenopausal bone loss. N Engl J Med 1983; 309: 1405-1407.