Hormonal contraception and bone metabolism
ESC Congress Library. Di Carlo C. May 29, 2014; 53320; S03.4 Disclosure(s): I have worked as a consultant for the following companies Bayer Gedeon Richter Merck MSD TEVA
Prof. Constantino Di Carlo
Prof. Constantino Di Carlo
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Learning Objectives
Abstract
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Understand the effects of hormonal contraceptives on bone in the general population and in particular subgroups such as adolescents, premenopausal women and women with menstrual irregularities.
Although a large amount of studies in literature evaluated the effects of hormonal contraception on bone many questions remained still unclear, such as the effect of these therapies on fracture risk.
Combined oral contraceptives (COCs) therapy does not seem to exert any significant effect on BMD in the general population. In adolescents, the effects of COCs on BMD seems to be mainly determined by estrogens dose. The use of COCs in perimenopausal women seems to reduce bone demineralization and may significantly increase BMD even at a 20%u03BCg dose. Use of DMPA is associated with a decrease in BMD, although this decrease seems to be partially reversible after discontinuation. Data on progestogen-only contraceptives, transdermal patch and vaginal ring are still limited, although it seems that these contraceptive methods do not exert any influence on BMD.
In conclusions, hormonal contraceptives do not seem to exert any significant effect on bone in the general population. However other randomized controlled trials are needed to evaluate the effects on fracture risk, since data available derived from studies having as primary endpoint the effects on BMD and BMD may not accurately reflect the real fracture risk.
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