Table 13 Perimenopausal women: positive 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) | Volpe et al80 | 17 perimenopausal women (ages 46–53) | OC treated (n = 8) v control (n = 9) for 36 months | Spine DXA | NS increase in BMD in OC users, decrease in BMD in non‐users |
| Cohort (level 2b,81,83,84 level 482) | Shargil81 | 200 perimenopausal women (ages 41–49) | Triphasic OC (30 μg EE+0.05 mg levonorgestrel x6, 40 μg EE+0.075 mg levonorgestrel x5, 30 μg EE+0.125 mg levonorgestrel x10) (n = 100) v control (n = 100) for 36 months | Lumbar spine, hand bone mass x ray/CT | No change in OC users v 6% decrease in BMD in controls |
| Gambacciani et al82 | 32 perimenopausal oligomenorrhoeic women | 30 μg EE+75 μg gestodene (n = 16) v 500 mg Ca2+ (n = 16) for 24 months | Radius DPA | Increase BMD with OC use | |
| Gambacciani et al83 | 90 perimenopausal (27 eumenorrhoeic, 54 oligomenorrhoeic) women | 20 μg EE+0.15 mg desogestrel (n = 27) v500 mg Ca2+ (n = 27) for 24 months | Lumbar spine DXA | Increase in BMD with OC use v decrease BMD with calcium | |
| Gambacciani et al84 | 55 perimenopausal (18 eumenorrhoeic, 37 oligomenorrhoeic) women | 20 μg EE+0.15 mg desogestrel v 500 mg Ca2+ for 24 months | Femoral neck, Ward's triangle, trochanter DXA | Increase in femoral neck BMD from baseline with OC use v decrease in femoral neck, Ward's triangle, trochanter BMD from baseline with calcium | |
| Cross sectional | Enzelsberger et al85 | 200 perimenopausal women | >10years OC use (n = 30) v 2–9 years OC use (n = 50) v never use (n = 120) | Forearm SPA | OC use for >10 years associated with increase in BMD |
| Tuppurainen et al86 | 3222 perimenopausal women | 29% ever OC use | Lumbar spine, femoral neck DXA | Ever OC users had increase spinal BMD v never users | |
| Masaryk et al87 | 2038 women (98 peri‐, 1940 post‐menopausal) | 18.3% ever OC use | Lumbar spine, hip DXA | Ever OC users had increase in spinal BMD v never users |
OC, Oral contraceptive; BMD, bone mineral density; RCT, randomised controlled trial; DXA, dual energy x ray absorptiometry; NS, non‐significant; EE, ethinyl oestradiol; CT, computed tomography; DPA, dual photon absorptiometry; SPA, single photon absorptiometry.