口服避孕药的使用与青少年和年轻成年女性骨密度变化：一项关于年龄、激素剂量和停药的前瞻性研究。
Oral contraceptive use and bone density change in adolescent and young adult women: a prospective study of age, hormone dose, and discontinuation.
机构信息
Group Health Research Institute, Group Health Cooperative, 1730 Minor Avenue, 16th Floor, Seattle, Washington 98101, USA.
出版信息
J Clin Endocrinol Metab. 2011 Sep;96(9):E1380-7. doi: 10.1210/jc.2010-3027. Epub 2011 Jul 13.
CONTEXT
Oral contraceptive (OC) use is common, but bone changes associated with use of contemporary OC remain unclear.
OBJECTIVE
The objective of the study was to compare bone mineral density (BMD) change in adolescent and young adult OC users and discontinuers of two estrogen doses, relative to nonusers.
DESIGN AND SETTING
This was a prospective cohort study, Group Health Cooperative.
PARTICIPANTS
Participants included 606 women aged 14-30 yr (50% adolescents aged 14-18 yr): 389 OC users [62% 30-35 μg ethinyl estradiol (EE)] and 217 age-similar nonusers; there were 172 OC discontinuers. The 24-month retention was 78%.
MAIN OUTCOME MEASURE
The main outcome measure was BMD measured at 6-month intervals for 24-36 months.
RESULTS
After 24 months, adolescents using 30-35 μg EE OCs, but not those using lower-dose OCs, had significantly smaller adjusted mean percentage BMD gains than nonusers at the spine [group means (95% confidence interval for between group differences) 1.32 vs. 2.26% (-1.89, -0.13%)] and whole body [1.45 vs. 2.03% (-1.29%, -0.13%)]. Adolescents who discontinued 30-35 μg EE OC showed significantly smaller gains than nonusers at the spine after 12 months [0.51 vs. 1.72% (-2.38%, -0.30%)]. Young adult OC users did not differ from nonusers. However, OC discontinuers of both doses differed significantly from nonusers at the spine 12 months after discontinuation [-1.32% < 30 μg EE, -0.92% 30-35 μg EE vs. +0.27% nonusers (-2.48, -0.54, and -1.94%, -0.55%, respectively)]. Results were similar for mean absolute BMD change (grams per square centimeter).
CONCLUSIONS
Both OC use and discontinuation were associated with BMD losses/smaller gains relative to nonusers (differences < 2% after 12-24 months for all skeletal sites). The clinical significance of these results regarding future fracture risk is unknown. Study of longer-term trends after discontinuation is needed.
背景
口服避孕药（OC）的使用很常见，但与当代 OC 使用相关的骨变化仍不清楚。
目的
本研究的目的是比较两种雌激素剂量的青少年和年轻成年 OC 使用者和停药者与未使用者的骨密度（BMD）变化。
设计和设置
这是一项前瞻性队列研究，参与者为 Group Health Cooperative 的 606 名年龄在 14-30 岁的女性（50%为 14-18 岁的青少年）：389 名 OC 使用者[62%使用 30-35μg 乙炔雌二醇（EE）]和 217 名年龄相似的未使用者；有 172 名 OC 停药者。24 个月的保留率为 78%。
主要观察指标
主要观察指标是在 24-36 个月的 6 个月间隔内测量的 BMD。
结果
24 个月后，使用 30-35μg EE OC 的青少年，而不是使用低剂量 OC 的青少年，与未使用者相比，脊柱的 BMD 增加百分比明显较小[组均值（95%置信区间）（组间差异）1.32%（-1.89%，-0.13%）]和全身[1.45%（-1.29%，-0.13%）]。12 个月后，停止使用 30-35μg EE OC 的青少年在脊柱处的 BMD 增加明显小于未使用者[0.51%（-2.38%，-0.30%）]。年轻成年 OC 使用者与未使用者无差异。然而，两种剂量的 OC 停药者在停药后 12 个月时与未使用者在脊柱处差异显著[-1.32%（30μg EE 以下），-0.92%（30-35μg EE）与 0.27%（未使用者）（-2.48%，-0.54%，和-1.94%，-0.55%，分别）]。对于平均绝对 BMD 变化（每平方厘米克数），结果相似。
结论
OC 的使用和停药都与未使用者相比，BMD 损失/增加幅度较小（所有骨骼部位 12-24 个月后差异<2%）。关于未来骨折风险，这些结果的临床意义尚不清楚。需要研究停药后更长期的趋势。
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