Adolescent use of combined hormonal contraception and peak bone mineral density accrual: A meta‐analysis of international prospective controlled studies

.Azita Goshtasebi1,2| Tatjana Subotic Brajic1| Delia Scholes3|Tamara Beres Lederer Goldberg4| Abbey Berenson5| Jerilynn C. Prior1,2,61Centre for Menstrual Cycle and Ovulation Research, Endocrinology and Metabolism, University of British Columbia, Vancouver, British Columbia, Canada2British Columbia Women’s Health Research Institute, Vancouver, British Columbia, Canada3Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, Washington4Postgraduate Program in Gynecology, Obstetrics, and Mastology, Discipline of Adolescent Medicine, Department of Pediatrics, Botucatu Medicine School, São Paulo State University (UNESP), Botucatu, São, Brazil5Department of Obstetrics & Gynecology, The University of Texas Medical Branch, Galveston, Texas6School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, CanadaCorrespondenceJerilynn C. Prior, Centre for Menstrual Cycle and Ovulation Research, Endocrinology and Metabolism, University of British Columbia, Vancouver, BC, Canada.Email: jerilynn.prior@ubc.caFunding informationThere was no funding for this systematic review and meta‐analysis beyond donation‐based Centre for Menstrual Cycle and Ovulation/University of British Columbia infrastructure support.

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 oestrogen 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‐ to 24‐month BMD change in adolescent (12‐ to 19‐year‐old) women using CHC vs 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 vs CHC nonusers.

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 of −0.02 (95% confidence interval [CI]: −0.05 to 0.00) g/cm2 in CHC‐exposed adolescents (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 ado‐lescents (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