绝经前女性口服避孕药的使用与骨密度：来自加拿大多中心骨质疏松症研究的基于人群的横断面数据。
Oral contraceptive use and bone mineral density in premenopausal women: cross-sectional, population-based data from the Canadian Multicentre Osteoporosis Study.
作者信息
Prior J C, Kirkland S A, Joseph L, Kreiger N, Murray T M, Hanley D A, Adachi J D, Vigna Y M, Berger C, Blondeau L, Jackson S A, Tenenhouse A
机构信息
Department of Medicine, University of British Columbia, and Vancouver Hospital.
出版信息
CMAJ. 2001 Oct 16;165(8):1023-9.
BACKGROUND
Positive and negative effects on bone mineral density (BMD) have been described as a result of the premenopausal use of oral contraceptives (OCs); increased fracture rates have also been reported. This study assessed the relation between OC use and BMD in a population-based, 9-centre, national sample of women aged 25-45 years.
METHODS
Premenopausal women who had been enrolled in the Canadian Multicentre Osteoporosis Study were classified as having ever been OC users (> or = 3 months) or as having never been OC users (0 to < 3 months). Data were obtained through extensive questionnaires and measuring of participants' weight, height and the BMD of lumbar vertebrae and the proximal femur.
RESULTS
Of the sample of 524 women, whose mean age was 36.3 (standard deviation [SD] 5.9) years, 454 had used OCs; their mean age when they started using OCs was 19.8 (SD 3.5) years and the mean duration of use was 6.8 (SD 4.8) years. Women who had ever and those who had never used OCs showed no differences in age, age at menarche, parity, current calcium intake, exercise, body mass index (BMI), education, past irregular cycles or amenorrhea. OC users reported more alcohol and cigarette use and more use of medications to create regular cycles. Mean BMD values (adjusted for age, BMI and height) were 0.02-0.04 g/cm2 (that is, 2.3%-3.7%) lower in OC users, and were significantly lower in the spine and trochanter. The BMD of the spine in OC users was 1.03 (SD 0.12) g/cm2 versus 1.07 (SD 0.12) g/cm2 (95% confidence interval [CI] of difference -0.07 to -0.001) in those who had never used OCs. BMD was neither related to the duration of OC use nor to gynecological age at first use. Current and past users had similar BMD values.
INTERPRETATION
National, population-based data show lower BMD values for the trochanter and spine in premenopausal women who have used OCs compared with those who have never used OCs.
背景
绝经前使用口服避孕药（OCs）对骨矿物质密度（BMD）的正负影响均有相关描述；也有报道称骨折率有所增加。本研究在一个基于人群的、由9个中心参与的全国性样本中，评估了25至45岁女性使用OCs与BMD之间的关系。
方法
纳入加拿大多中心骨质疏松研究的绝经前女性被分为曾经使用过OCs（≥3个月）或从未使用过OCs（0至<3个月）。通过广泛的问卷调查以及测量参与者的体重、身高、腰椎和股骨近端的BMD来获取数据。
结果
在524名平均年龄为36.3（标准差[SD]5.9）岁的女性样本中，454人使用过OCs；她们开始使用OCs时的平均年龄为19.8（SD 3.5）岁，平均使用时长为6.8（SD 4.8）年。曾经使用过和从未使用过OCs的女性在年龄、初潮年龄、产次、当前钙摄入量、运动、体重指数（BMI）、教育程度、既往月经周期不规律或闭经情况方面均无差异。使用OCs的女性报告饮酒和吸烟更多，以及更多地使用药物来建立规律的月经周期。OCs使用者经年龄、BMI和身高调整后的平均BMD值低0.02 - 0.04 g/cm²（即2.3% - 3.7%），在脊柱和转子部位显著更低。使用OCs的女性脊柱BMD为1.03（SD 0.12）g/cm²，而从未使用过OCs的女性为1.07（SD 0.12）g/cm²（差异的95%置信区间[CI]为 - 0.07至 - 0.001）。BMD既与OCs的使用时长无关，也与首次使用时的妇科年龄无关。当前使用者和既往使用者的BMD值相似。
解读
基于全国人群的数据显示，与从未使用过OCs的绝经前女性相比，使用过OCs的女性转子和脊柱的BMD值更低。
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