Contraception
Volume 73, Issue 5 , Pages 445-469, May 2006

Combined hormonal contraception and bone health: a systematic review

  • Summer L. Martins

      Affiliations

    • Division of Reproductive Health, WHO Collaborating Center in Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA
    • ,
  • Kathryn M. Curtis

      Affiliations

    • Division of Reproductive Health, WHO Collaborating Center in Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA
    • Corresponding Author InformationCorresponding author. Tel.: +1 770 488 6397; fax: 770 488 6391.
    • ,
  • Anna F. Glasier

      Affiliations

    • Family Planning & Well Woman Services, National Health Service, Lothian Primary & Community Division, Edinburgh EH4 1NL, Scotland, UK
    • School of Clinical Sciences and Community Health, University of Edinburgh, Edinburgh EH8 9AG, Scotland, UK
    • Department of Public Health Policy, School of Hygiene and Tropical Medicine, University of London, London WC1E 7HT, England, UK

Received 14 December 2005; accepted 5 January 2006.

Abstract 

This systematic review examined whether women who use combined hormonal contraception experience changes in risk of fracture or bone mineral density (BMD) that differ from nonusers. We identified 86 articles from PubMed and EMBASE (published 1966 to August 2005) that reported on fracture or BMD outcomes by use of combined hormonal contraceptives. The evidence relating to combined oral contraceptives (COCs) and fracture is inconclusive, as results from the available studies conflict. Studies of adolescent and young adult women generally found lower BMD among COC users than nonusers. Evidence for premenopausal adult women suggested no differences in BMD between COC users and nonusers. COC use in perimenopausal and postmenopausal women preserved bone mass, while nonusers lost BMD, but BMD among former COC users in this age group was the same as for never-users. Evidence for other combined hormonal methods was very limited, with one study indicating no effect of combined hormonal injectable use among premenopausal women on BMD and one study suggesting lower BMD among premenopausal users of the NuvaRing than in nonusers.

Keywords: Hormonal contraception, Fracture, Bone mineral density, Systematic reviews

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PII: S0010-7824(06)00009-6

doi:10.1016/j.contraception.2006.01.003

Contraception
Volume 73, Issue 5 , Pages 445-469, May 2006

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