Steroidal contraceptives and bone fractures in women: evidence from observational studies

摘要: BACKGROUND: Age-related decline in bone mass increases the risk of skeletal fractures especially those hip spine and wrist. Steroidal contraceptives have been associated with changes mineral density women. Whether such affect later life is unclear. Hormonal are among most effective widely-used contraceptives. Concern about may limit use these Observational studies can collect data on premenopausal contraceptive as well fracture incidence life. OBJECTIVES: We systematically reviewed evidence from observational hormonal for contraception SEARCH METHODS: In May 2012 we searched studies. The databases included MEDLINE POPLINE Cochrane Central Register Controlled Trials (CENTRAL) LILACS EMBASE CINAHL Web Science. also recent clinical trials through ClinicalTrials.gov ICTRP. For other examined reference lists relevant articles wrote to investigators additional reports. SELECTION CRITERIA: cohort case-control use. Interventions comparisons a nonhormonal no or another contraceptive. primary outcome was fracture. DATA COLLECTION AND ANALYSIS: Two authors independently extracted data. One author entered into RevMan second verified accuracy. quality using Newcastle-Ottawa Quality Assessment Scale (NOS) developed Sensitivity analysis moderate high based our assessment NOS.Given need control confounding factors used adjusted estimates models reported by authors. Where did not analyses calculated odds ratio (OR) 95% confidence interval (CI). Due varied study designs conduct meta-analysis. MAIN RESULTS: 14 (7 7 studies). These oral (OCs) (N=12) depot medroxyprogesterone acetate (DMPA) (N=4) intrauterine device (IUD) (N=1). This section focuses six that sensitivity analysis.All noted few associations risk. found OC ever-users had increased all (reported RR 1.20; CI 1.08 1.34). However subset association except 10 years more since OR 1.55; 1.03 2.33). Another only who prescriptions 1.09; 1.16). A postmenopausal women after excluding prior little between subgroups longer specific intervals any young less than average use.Two progestin-only DMPA ever-use 1.44 (95% 1.01 2.06) four 2.16; 1.32 3.53) over 50 old. past including one two 1.17; 1.07 1.29) current 3 9 prescriptions. addition reduced IUD 0.75; 0.64 0.87) IUD. AUTHORS CONCLUSIONS: do indicate an overall Some user subgroups. users indicated be decreased because comparison groups usually differ. Researchers should clear variables multivariate analysis.