The effect of oral contraceptives on bone mass and stress fractures in female runners.
OBJECTIVE
To determine the effect of oral contraceptives (OC) on bone mass and stress fracture incidence in young female distance runners.


METHODS
One hundred fifty competitive female runners ages 18-26 yr were randomly assigned to OC (30 microg of ethinyl estradiol and 0.3 mg of norgestrel) or control (no intervention) for 2 yr. Bone mineral density (BMD) and content (BMC) were measured yearly by dual x-ray absorptiometry. Stress fractures were confirmed by x-ray, magnetic resonance imaging, or bone scan.


RESULTS
Randomization to OC was unrelated to changes in BMD or BMC in oligo/amenorrheic (N=50) or eumenorrheic runners (N=100). However, treatment-received analyses (which considered actual OC use) showed that oligo/amenorrheic runners who used OC gained about 1% per year in spine BMD (P<0.005) and whole-body BMC (P<0.005), amounts similar to those for runners who regained periods spontaneously and significantly greater than those for runners who remained oligo/amenorrheic (P<0.05). Dietary calcium intake and weight gain independently predicted bone mass gains in oligo/amenorrheic runners. Randomization to OC was not significantly related to stress fracture incidence, but the direction of the effect was protective in both menstrual groups (hazard ratio [95% CI]: 0.57 [0.18, 1.83]), and the effect became stronger in treatment-received analyses. The trial's statistical power was reduced by higher-than-anticipated noncompliance.


CONCLUSIONS
OC may reduce the risk for stress fractures in female runners, but our data are inconclusive. Oligo/amenorrheic athletes with low bone mass should be advised to increase dietary calcium and take steps to resume normal menses, including weight gain; they may benefit from OC, but the evidence is inconclusive.
Cobb
Kristin L
KL
Department of Health Research and Policy, Stanford University School of Medicine, Stanford, CA 94305, and Clinical Research Center, Helen Hayes Hospital, West Haverstraw, NY, USA. kcobb@stanford.edu
Bachrach
Laura K
LK
Sowers
Maryfran
M
Nieves
Jeri
J
Greendale
Gail A
GA
Kent
Kyla K
KK
Brown
Byron W
BW
Pettit
Kate
K
Harper
Diane M
DM
Kelsey
Jennifer L
JL
D000293:Adolescent; D000328:Adult; D000568:Amenorrhea / Q000150:complications / Q000188:drug therapy; D015519:Bone Density / Q000187:drug effects*; D003278:Contraceptives, Oral, Hormonal / Q000009:adverse effects / Q000627:therapeutic use*; D002149:Energy Intake / Q000502:physiology; D005260:Female; D015775:Fractures, Stress / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D009839:Oligomenorrhea / Q000150:complications / Q000188:drug therapy; D018570:Risk Assessment; D012420:Running / Q000293:injuries* / Q000502:physiology; D014481:United States / Q000453:epidemiology