Adolescent Use of Combined Hormonal Contraception and Peak Bone Mineral Density Accrual: a meta‐analysis of international prospective controlled studies

Summary

Objective

Many women use combined hormonal contraceptives (CHC) during adolescence during which they are accruing peak areal bone mineral density (BMD) that relates to lifetime fracture risk. To build BMD requires formation with which CHC‐related exogenous estrogen may interfere. We compared peak BMD accrual in adolescents using and not using CHC.

Design/Participants

We performed literature searches for prospective published peer‐reviewed articles providing 12‐24 month BMD change in adolescent (12‐19‐year‐old) women using CHC versus CHC‐unexposed control women.

Methods

Meta‐analyses used random‐effects models to assess BMD change rate at lumbar spine (LS) and other sites in adolescent CHC‐users versus non‐CHC users.

Results

Literature searches yielded 84 publications of which nine were eligible. Adolescent‐only data were sought from cohorts with wider age inclusions. The 12‐month LS meta‐analysis with eight paired comparisons in 1535 adolescents showed a weighted mean BMD difference in CHC‐exposed of ‐0.02 (95% Confidence Interval [CI]: ‐0.05 to 0.00) g/cm2 (P = 0.04). The 24‐month LS meta‐analysis with five paired comparisons in 885 adolescents showed a highly significant weighted mean BMD difference of ‐0.02 (95% CI: ‐0.03 to ‐0.01) g/cm2 in CHC exposed adolescents (P = 0.0006). Heterogeneities by I² were 96 and 85% respectively. Insufficient data for other bone sites precluded quantitative analysis.

Conclusion

Given that adolescent exposure to CHC appears to be increasing, this evidence for potential impairment of peak spinal BMD accrual is of concern and suggests a potential public health problem. Randomized controlled trial data are needed to determine CHC effects on adolescent bone health.

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