Elsevier

Maturitas

Volume 54, Issue 2, 20 May 2006, Pages 176-180
Maturitas

Longitudinal evaluation of perimenopausal bone loss: Effects of different low dose oral contraceptive preparations on bone mineral density

https://doi.org/10.1016/j.maturitas.2005.10.007Get rights and content

Abstract

Objectives

To evaluate the pattern of mineral density in eumenorrhoic and oligomenorrhoic perimenopausal women, and assess the effects of different low dose oral contraceptives (OC) on bone metabolism and spine bone density.

Methods

Spine bone density was evaluated in a longitudinal 2-year follow-up, randomized, unblinded, uncontrolled clinical trial conducted in healthy, normally menstruating perimenopausal women, perimenopausal oligomenorrhoic women and in perimenopausal oligomenorrhoic women treated with an oral contraceptive containing 20 mcg ethinyl estradiol plus 0.15 mg desogestrel, 0.100 mg levonorgestrel, 0.75 mg of gestodene (n = 15 in each group). The results were analyzed by factorial or repeated measures analysis of variance, as appropriate.

Results

During the observation period, in normal menstruating women there were no changes in menstrual cycle, plasma FSH and estradiol levels, and spine bone density. In oligomenorrhoic untreated women an increase in cycle length, with a concomitant decrease in plasma estradiol and an increase in plasma FSH levels were evidenced (p < 0.05). In this group a significant decrease in bone density (p < 0.05) occurred. In OC-treated women, a significant (p < 0.05) increase in bone density was observed, with no differences among different groups.

Conclusion

Different progestins used in OC preparations do not modify the bone sparing effect of perimenopausal OC administration avoiding the decrease in bone density.

Introduction

Low bone mineral density is an important determinant of fracture risk and the chronic hypoestrogenism in the first postmenopausal years can cause a critical bone density decrease [1], [2], [3], [4]. Hormone replacement therapy prevents the reduction in bone density related to the postmenopausal hypoestrogenism [5], [6]. During the menopausal transition, a progressive impairment in bone metabolism and a significant bone loss can occur, particularly in women suffering from hypoestrogenic oligomenorrhea [7], [8], [9], [10], [11]. We have reported that the administration of oral contraceptives (OC) containing low dose ethinyl estradiol is able to prevent the perimenopausal decrease in radial [10], vertebral [11] and femur [12] bone density. However, the bone effects of different doses, type and preparations may differ. The possible effects of different steroids in the modulation of bone metabolism and density have been recently reviewed and discussed [13]. The aim of the present study was to evaluate the possible effects of different progestins contained in OC preparations with the same ethinyl estradiol (20 mcg) content on spine bone density in perimenopausal women.

Section snippets

Materials and methods

In the present study, we enrolled women, aged 40–49 years, attending the Menopause Clinic of our Department. Bone density was measured as a part of the screening program for perimenopausal women. Out of them, 20 women reported regular menstrual cycles, while 80 women experienced oligomenorrhea in the 3–6 months before they entered the study. Oligomenorrhea was defined as episodes of menstrual bleeding occurring at intervals of more than 35 and less than 90 days. Regardless to their menstrual

Results

There were no significant differences in age, body mass index (BMI) (Table 1), hormone values and spine BMD (Table 2), in the different groups before the study. During the 24 months observation period, no modification in the menstrual pattern or in plasma hormone levels was observed in eumenorrhoic women (Table 2). Conversely, in oligomenorrhoic subjects an increase in cycle length was evident, with a significant (p < 0.05) increase in circulating plasma FSH, that paralleled a significant (p < 

Discussion

To our knowledge, this is the first longitudinal study that evaluates the possible influence of different progestins on the OCs effects on BMD in perimenopausal women. These results confirm that a gradual decrease in spine bone density takes place during the perimenopausal years [7], [8], [9], [10], [11], [12]. The bone loss characterises the perimenopausal women suffering from hypoestrogenic oligomenorrhea. In fact, no evidences of a bone loss was evident in age-matched, normally menstruating

References (17)

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