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Effect of progestogen-only contraception on premenopausal fracture risk: a case-control study

Kyvernitakis I1,2,3Kostev K4Thomasius F5Stumpf U6Hadji P7,5.

Osteoporos Int. 2020 May 6. doi: 10.1007/s00198-020-05437-6. [Epub ahead of print]

 

Abstract

Our study demonstrated that progestogen-only oral and intrauterine contraceptives are not associated with fracture risk independent from age.

PURPOSE:

The use of progestogen-only contraception, resulting in a hypoestrogenic state, has been associated with impaired bone acquisition and increased fracture risk. The aim of this large population-based study was to assess the fracture risk in association with the use of progestogen-only contraceptives (progestogen-only pills (POPs) and progestogen-containing IUDs (LNG-IUD)).

METHODS:

We identified 14,421 women between 16 and 55 years of age with a first-time diagnosis of fracture and matched them with 14,421 random controls using the Disease Analyzer Database.

RESULTS:

The results of the first adjusted logistic regression model (ever use vs. never use of progestogen-only contraceptives) revealed that there was no significant association between the use of POPs (OR = 0.98, 95% CI 0.90-1.07, p = 0.657) or LNG-IUDs (OR = 0.99, 95% CI 0.81-1.21, p = 0.945) and fracture incidence. Also, in the second regression model, we observed no effect of duration of use of POPs (OR = 1.01, 95% CI 0.98-1.03, p = 0.672) or LNG-IUDs (OR = 0.94, 95% CI 0.87-1.02, p = 0.177) on fracture occurrence. We also observed no effect in different age groups.

CONCLUSION:

Our study results indicate that progestogen-only contraception (either POPs or LNG-IUPs) is not associated with fracture risk and may be considered a bone-safe option for adults and adolescents.