Use Reduces Peak Bone Mass, Leads to Osteoporosis
by Barbara Minton
TBYIL articles by Barbara Minton
Many parents wonder how to
advise their daughters who are ready for contraceptives. The consequences of
not using contraceptives can be life altering, but so can the consequences
of using them. To make it even more complicated, recent research has shown
that contraceptive use during adolescence prevents peak bone mass
acquisition, leading to significantly increased risk of osteoporosis and
fractures later in life.
As reported in the journal Contraception, researchers designed a four year
follow-up study with 122 adolescent women ranging in ages from 12 to 19. The
collected data was divided into three groups based on estrogen-progestin
contraceptive use: nonusers, those with 1-2 years of use, and those with
more than 2 years of use. Height, weight, and the amount of exercise as well
as bone mineral content of the lumbar spine and femoral neck (found where
the femur joins the hip) were measured repeatedly.
The researchers found a significant trend showing less of an increase in the
mean adjusted bone mineral content of the lumbar spine in the group who had
used a contraceptive for more than 2 years compared with the two other
groups. These findings led the researchers to conclude that
estrogen-progestin contraceptive preparations suppress normal bone mineral
The hormones used in contraceptives are synthetic or semi-synthetic, and
differ in molecular structure from the hormones naturally made by the female
body. They are hormone drugs, not natural hormones or bioidentical hormones.
During the period from childhood to early adulthood, minerals are deposited
in bone as the skeleton grows. The highest rates of bone growth occur during
infancy and again in the pubertal growth spurt. During adolescence the speed
of bone growth doubles, and around 40% of peak bone mass is created. By the
age of about 20, up to 95% of peak bone mass is attained.
As the journey through the 20’s continues, bone mass starts to decline.
Minerals and the collagen matrix begin to be removed from bone more rapidly
than new bone tissue is added. By old age, women have typically lost half of
their trabecular and one-third of their cortical bone.
It can be clearly seen that the amount of bone achieved at peak bone mass
dictates the amount of bone to be had throughout the rest of life. There is
increasing evidence that the groundwork for the development of osteoporosis
is laid during the period of childhood and adolescence. Researchers are now
at work determining the extent to which the diet and lifestyle choices we
make for our children can predict their fracture risk later in life.
What is already known is that a balanced diet of mineral rich whole foods
sets the stage for optimal peak bone mass growth. This outcome can be
negatively affected by the consumption of foods that deplete the mineral
content of the skeleton such as soft drinks that are high in phosphorus,
eating products made with soy, or by lack of exercise. And now we know that
this outcome is also dependent on lifestyle choices such as the choice to
use contraceptives. These research findings suggest that the incredible rise
in the rates of diagnosed osteoporosis may be directly tied to the huge
increase in use of contraceptives in the last 40 years.
The above noted study lends additional support to the conclusions of
previous research. In 2001, the Canadian Medical Association reported
research to assess the relation between oral contraceptive use and bone
mineral density in a population based national sample of women aged 25-45.
Premenopausal women who had been enrolled in the Canadian Multi-Centre
Osteoporosis Study were classified as having ever been users of oral
contraceptives, or as having never been users of oral contraceptives. Data
was obtained through extensive questionnaires and by measuring participants’
weight, height and the bone mineral density of lumbar vertebrae and of the
Of the sample of 524 women, whose mean age was 36.3 years, 454 had used oral
contraceptives. The mean age when they started using the contraceptives was
19.8, and the mean duration of use was 6.8 years. There was no difference
between the groups in age, age at menarche, parity, current calcium intake,
exercise, body mass index, irregular cycles, or amenorrhea. However, the
mean bone mineral density was 2.3-3.7% lower in contraceptive users, and
significantly lower in the spine and trachanter.
A study reported in the 1995 journal Contraception was designed to
investigate bone metabolism in young women taking an oral contraceptive for
over 5 years. Two hundred healthy women between 19 and 22 years of age were
divided into two groups. Group A received an oral contraceptive, Group B did
not receive any treatment. All the subjects underwent a bone mass density
evaluation of spinal level at baseline and every 12 months during the 5
Results indicated that Group A did not show any significant bone mineral
density change after 5 years on oral contraceptive treatment, while Group B
showed a significant increase in bone mass content at the end of the time of
observations (+7.8% after 5 years).
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