Ivansson Emma L, Johansson Therese, Karlsson Torgny, Johansson Åsa
Department of Immunology, Genetics and Pathology, Science for Life Laboratory, Uppsala University, Uppsala, Sweden.
KTH, Science for Life Laboratory, Stockholm, Sweden.
Eur J Epidemiol. 2025 Jul 9. doi: 10.1007/s10654-025-01273-2.
Osteoporotic fractures, largely resulting from reduced estrogen levels after menopause and subsequent bone loss, are a leading cause of disability among older women. Although oral contraceptive pills (OCPs) contain estrogen, their long-term impact on bone health and osteoporosis risk remain uncertain. Here, we assessed the effect of OCP use on bone mineral density (BMD) and osteoporosis using data from 257,185 women from the UK Biobank, born 1936-1970. Time-dependent Cox regression was used to estimate adjusted hazard ratios (HRs) and 95% confidence intervals (CI) for osteoporosis, while multivariable linear regression was used to assess the effect of OCP use on BMD, measured as T-scores in standard deviation units based on quantitative ultrasound of the calcaneus. By the end of follow-up in 2020, 7.6% of the participants had received an osteoporosis diagnosis. The rate of osteoporosis was lower among ever OCP users (HR = 0.86; 95% CI 0.83-0.89; P = 2.8 × 10). OCP use was also associated with a higher BMD T-score (0.052; 0.038-0.067; P = 2.1 × 10) with an increasing effect with longer use. Use of OCPs for 0-1 years had no significant effect on BMD (P = 0.081). However, longer durations were associated with increased BMD T-scores compared to never users: 2-5 years (0.046; 0.027-0.065, P = 2.2 × 10), 6-10 years (0.062; 0.043-0.080; P = 3.5 × 10), 11-15 years (0.062; 0.042-0.081; P = 3.2 × 10) and 16 + years (0.064; 0.044-0.083; P = 1.2 × 10). We found prior OCP use to be associated with higher BMD and a reduced risk of osteoporosis, potentially offering long-term benefits and suggesting that OCP use could reduce osteoporotic complications in older women.
骨质疏松性骨折主要是由绝经后雌激素水平降低及随后的骨质流失引起的，是老年女性致残的主要原因。尽管口服避孕药（OCPs）含有雌激素，但其对骨骼健康和骨质疏松风险的长期影响仍不确定。在此，我们利用英国生物银行中257185名出生于1936年至1970年的女性的数据，评估了使用OCPs对骨密度（BMD）和骨质疏松的影响。采用时间依赖性Cox回归来估计骨质疏松的调整后风险比（HRs）和95%置信区间（CI），同时使用多变量线性回归来评估使用OCPs对BMD的影响，BMD以基于跟骨定量超声的标准差单位T分数来衡量。到2020年随访结束时，7.6%的参与者被诊断为骨质疏松。曾经使用过OCPs的人群中骨质疏松的发生率较低（HR = 0.86；95% CI 0.83 - 0.89；P = 2.8×10）。使用OCPs还与更高的BMD T分数相关（0.052；0.038 - 0.067；P = 2.1×10），且使用时间越长影响越大。使用OCPs 0至1年对BMD没有显著影响（P = 0.081）。然而，与从未使用者相比，使用时间更长与BMD T分数增加相关：2至5年（0.046；0.027 - 0.065，P = 2.2×10），6至10年（0.062；0.043 - 0.080；P = 3.5×10），11至15年（0.062；0.042 - 0.081；P = 3.2×10）以及16年以上（0.064；0.044 - 0.083；P = 1.2×10）。我们发现既往使用OCPs与更高的BMD以及更低的骨质疏松风险相关，这可能带来长期益处，并表明使用OCPs可以减少老年女性的骨质疏松并发症。
