Key clinical point: Progestogen-only oral and intrauterine contraceptives are not associated with premenopausal fracture risk and may be considered a bone-safe option for adults and adolescents.

Major finding: The use of progestogen-only pills (odds ratio [OR], 0.95; P = .289) and progestogen-containing intrauterine devices (OR, 0.99; P = .903) was not associated with fracture risk. The duration of use had no influence on fracture occurrence; no effect was observed in different age groups.

Study details: This case-control study included 14,476 women with fractures (age range, 16-55 years) and 14,476 matched women without fractures (controls).

Disclosures: No study sponsor was identified. The authors declared no conflicts of interest.

Citation: Kyvernitakis I et al. Osteoporos Int. 2020 May 06. doi: 10.1007/s00198-020-05437-6.

Commentary

“Progestogen-only contraception leads to a hypoestrogenic state, which has been associated with decreased bone formation and increased fracture risk. This large case-control population-based study conducted in the UK included 14,476 females aged 16-55 years with fracture and 14,476 control females who were individually matched by several factors including age, BMI, smoking behavior, type of physician and index year.

No statistically significant association was found between fracture risk and the use of progestogen-only contraceptives (progestogen-only pills and progestogen-containing intrauterine devices). Importantly, the duration of use of progesterone-only contraceptives did not affect fracture risk. While these findings support the idea that progesterone-only pills and progesterone-containing intrauterine devices are not associated with fractures among females age 16-55 years, it is unclear whether this type of contraceptive may affect risk of fracture in long-term.”

Maria I. Danila, MD, MSc, MSPH

University of Alabama at Birmingham