. 2006 Jan;40(1):11–24. doi: 10.1136/bjsm.2005.020065

Table 11 Anorexic premenopausal women: no effect of oral contraceptives on bone mineral density.

Study design	Reference	No of patients	OC exposure	Measurement of BMD/bone metabolism	Results
RCT (level 1b)	Klibanski et al⁷⁴	48 women with AN (ages 16–42)	0.625 mg Premarin/5 mg Provera (n = 16) v 35 μg EE (n = 6) v control (n = 26) for 18 months	Lumbar spine CT	No significant changes in BMD between oestrogen treated and control groups; 4% increase in BMD in oestrogen treated patients with initial ideal body weight of <70% v 20% decrease in BMD in control patients with initial ideal body weight of <70%
	Gordon et al⁷⁵	51 women with AN (ages 14–28)	20 μg EE +0.1 mg levonorgestrel v 50 mg dehydroepiandrosterone for 12 months	Lumbar spine, total body, total hip, femoral neck, trochanter DXA; serum osteocalcin, BSAP, urinary NTx	NS increase in lumbar BMD in both groups; decrease in urinary NTx in both groups (suggesting decrease in resorption)
	Grinspoon et al⁷⁶	60 women with AN	35 μg EE+0.4 mg norethindrone (n = 15) v 30 μg/kg rhIGF‐I (n = 14) v 30 μg/kg rhIGF‐I+35 μg EE+0.4 mg norethindrone (n = 16) v control (placebo rhIGF‐I, no OC) (n = 15) for 9 months	Lumbar spine, total body, distal radius, total hip, femoral neck DXA	Factorial analysis: no effect of OC on BMD at any site; 4‐group analysis: increase in AP lumbar BMD in combined rhIGF‐I+OC group v baseline and v placebo; Overall: OCs may augment effects of rhIGF‐I on BMD, but are not effective alone
Cohort (level 2b)	Golden et al⁷⁷	50 women with AN (ages 13–21)	Oestrogen treatment: OrthoTri‐Cyclen (35 μg EE+0.18 mg norgestimate, days 1–7; 35 μg EE+0.215 mg norgestimate, days 8–14; 35 μg EE+0.25 mg norgestimate, days 15–21) (n = 10), Ortho‐Cyclen (35 μg EE+0.25 mg norgestimate) (n = 6), Lo‐Ovral (30 μg EE + 0.3 mg norgestrel) (n = 2), Lo‐Estrin (30 μg EE + 1.5 mg norethindrone) (n = 2), Levlen (30 μg EE + 0.15 mg levonorgestrel) (n = 1), Alesse (20 μg EE + 0.1 mg levonorgestrel) (n = 1) (n = 22) v control (n = 28) for 36 months	Lumbar spine, left hip DXA	Initial BMDs were decreased compared with the young adult reference mean; no significant changes in BMD from baseline in either oestrogen treated or control groups
Case series (level 4)	Muñoz et al⁷⁸	38 women with AN (mean age 17.3 years)	50 μg EE+0.5 mg norgestrel for 12 months	Lumbar spine DXA	No change in BMD from baseline

OC, Oral contraceptive; BMD, bone mineral density; RCT, randomised controlled trial; AN, anorexia nervosa; EE, ethinyl oestradiol; CT, computed tomography; NS, non‐significant; DXA, dual energy x ray absorptiometry; BSAP, bone specific alkaline phosphatase; NTx, N‐telopeptides; rhIGF‐I, recombinant human insulin‐like growth factor I.