Research Article| Volume 182, ISSUE 2, P265-269, February 2000

Download started.


Oral contraceptives and bone mineral density: A population-based study


      Objective: We sought to test the hypothesis that exposure to oral contraceptives protects the skeleton. Study Design: Multiple regression techniques were used to analyze data for a random sample of 710 Australian women (age range, 20-69 years). Bone mineral density was measured at the lumbar spine, proximal femur, whole body, and distal forearm. Oral contraceptive exposure was assessed by a questionnaire. Results: Women exposed to oral contraceptives had a 3.3% greater mean bone mineral density adjusted for body mass index and age at the lumbar spine (partial r2 = 0.009; P = .014). Adjusted mean vertebral bone mineral density was 3.3% greater for premenopausal women (partial r2 = 0.008; P < .05), but the effect did not reach significance among postmenopausal women. Higher bone mineral density was associated with increased duration of exposure, with a mean increase of 3.2% associated with the first 5 years and a further 0.2% with ≥5 years of exposure. No association was detected at other sites. Conclusion: Exposure to oral contraceptives may be associated with higher lumbar spine bone mineral density. (Am J Obstet Gynecol 2000;182:265-9.)


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to American Journal of Obstetrics & Gynecology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Felson DT
        • Zhang Y
        • Hannan MT
        • Kiel DP
        • Wilson PWF
        • Anderson JJ
        The effect of postmenopausal estrogen therapy on bone density in elderly women.
        N Engl J Med. 1993; 329: 1141-1146
        • Goldsmith NF
        • Johnston JO
        Bone mineral: effects of oral contraceptives, pregnancy, and lactation.
        J Bone Joint Surg Am. 1975; 57: 657-668
        • Lindsay R
        • Tohme J
        • Kanders B.
        The effect of oral contraceptive use on vertebral bone mass in pre- and post-menopausal women.
        Contraception. 1986; 34: 333-340
        • Enzelsberger H
        • Metka M
        • Heytmanek G
        • Schurz B
        • Kurz Ch
        • Kusztrich M.
        Influence of oral contraceptive use on bone density in climacteric women.
        Maturitas. 1988; 9: 375-378
        • Stevenson JC
        • Lees B
        • Devenport M
        • Cust MP
        • Ganger KF
        Determinants of bone density in normal women: risk factors for future osteoporosis?.
        BMJ. 1989; 298: 924-928
        • Kleerekoper M
        • Brienza RS
        • Schultz LR
        • Johnson CC
        Oral contraceptive use may protect against low bone mass.
        Arch Intern Med. 1991; 151: 1971-1976
        • Recker RR
        • Davies KM
        • Hinders SM
        • Heaney RP
        • Stegrnan MR
        • Kimmel DB
        Bone gain in young adult women.
        JAMA. 1992; 268: 2403-2408
        • Kritz-Silverstein D
        • Barrett-Connor E.
        Bone mineral density in postmenopausal women as determined by prior oral contraceptive use.
        Am J Public Health. 1993; 83: 100-102
        • Hreshchyshyn MM
        • Hopkins A
        • Zylstra S
        • Anbar M.
        Associations of parity, breast-feeding, and birth control pills with lumbar spine and femoral neck bone densities.
        Am J Obstet Gynecol. 1988; 159: 318-322
        • Lloyd T
        • Buchanan JR
        • Ursino GR
        • Myers C
        • Woodward G
        • Halbert DR
        Long-term oral contraceptive use does not affect trabecular bone density.
        Am J Obstet Gynecol. 1989; 160: 402-404
        • Mazess RB
        • Barden HS
        Bone density in premenopausal women: effects of age, dietary intake, physical activity, smoking, and birth-control pills.
        Am J Clin Nutr. 1991; 53: 132-142
        • Murphy S
        • Khaw KT
        • Compston JE
        Lack of relationship between hip and spine bone mineral density and oral contraceptive use.
        Eur J Clin Invest. 1993; 23: 108-111
        • Mais V
        • Fruzzetti F
        • Ajossa S
        • Paoletti AM
        • Guerriero S
        • Melis GB
        Bone metabolism in young women taking a monophasic pill containing 20 mcg ethinylestradiol: a prospective study.
        Contraception. 1993; 48: 445-452
        • Haapasalo H
        • Kannus P
        • Sievanen H
        • Pasanen M
        • Uusi-Rasi K
        • Heinonen A
        • et al.
        Development of mass, density, and estimated mechanical characteristics of bones in Caucasian females.
        J Bone Miner Res. 1996; 11: 1751-1760
        • Matkovic V
        • Jelic T
        • Wardlaw GM
        • Ilich JZ
        • Goel PK
        • Wright JK
        • et al.
        Timing of peak bone mass in Caucasian females and its implication for the prevention of osteoporosis. Inference from a cross-sectional model.
        J Clin Invest. 1994; 93: 799-808
        • Riggs BL
        • Wahner HW
        • Melton III, LJ
        • Richelson LS
        • Judd HL
        • Offord KP
        Rates of bone loss in the appendicular and axial skeletons of women. Evidence of substantial vertebral bone loss before menopause.
        J Clin Invest. 1986; 77: 1487-1491
        • Baran D
        • Sorensen A
        • Grimes J
        • Lew R
        • Karellas A
        • Johnson B
        • et al.
        Dietary modification with dairy products for preventing vertebral bone loss in premenopausal women: a three-year prospective study.
        J Clin Endocrinol Metab. 1990; 70: 264-270
        • Hedlund LR
        • Gallagher JC
        The effect of age and menopause on bone mineral density of the proximal femur.
        J Bone Miner Res. 1989; 4: 639-642
        • Duppe H
        • Gardsell P
        • Johnell O
        • Nilsson BE
        Bone mineral content in women: trends of change.
        Osteoporos Int. 1992; 2: 262-265
        • Seeman E
        • Wahner HW
        • Offord KP
        • Kumar R
        • Johnson WJ
        • Riggs BL
        Differential effects of endocrine dysfunction on the axial and the appendicular skeleton.
        J Clin Invest. 1982; 69: 1302-1309
        • Ott R.
        An introduction to statistical methods and data analysis.
        in: 4th ed. Wadsworth, Inc, California1993: 647-733
        • Sowers MR
        • Wallace RB
        • Lemke JH
        Correlates of mid-radius bone density among postmenopausal women: a community study.
        Am J Clin Nutr. 1985; 41: 1045-1053
        • Hartard M
        • Bottermann P
        • Bartenstein P
        • Jeschke D
        • Schwaiger M.
        Effects on bone mineral density of low-dosed oral contraceptives compared to and combined with physical activity.
        Contraception. 1997; 55: 87-90
        • Harlow SD
        • Linet MS
        Agreement between questionnaire data and medical records. The evidence for accuracy of recall.
        Am J Epidemiol. 1989; 129: 233-248
        • Horsman A
        • Jones M
        • Francis R
        • Nordin C.
        The effect of estrogen dose on postmenopausal bone loss.
        N Engl J Med. 1983; 309: 1405-1407
        • Melton III, LJ
        • Atkinson EJ
        • O’Fallon WM
        • Wahner HW
        • Riggs BL
        Long-term fracture prediction by bone mineral assessed at different skeletal sites.
        J Bone Miner Res. 1993; 8: 1227-1233