Bone health in estrogen-free contraception
P Hadji1,2, E Colli3, P-A Regidor4
1Frankfurter Center of Bone Health, Goethestr. 23, 60313, Frankfurt/Main, Germany.
Summary
New estrogen-free contraceptives may impact bone turnover. Estrogen inhibits bone resorption, while progestogens have varied effects. Bone mass acquired during development is crucial for preventing fractures later in life.
Area of Science:
- Endocrinology
- Bone Biology
- Pharmacology
Background:
- Estrogens and progestogens significantly influence bone metabolism.
- Estrogen primarily inhibits bone resorption, while progestogens act via specific receptors.
- Adequate bone acquisition during development is critical for preventing fragility fractures in later life.
Purpose of the Study:
- To review the effects of estrogens and progestogens on bone turnover.
- To discuss new estrogen-free contraceptives and their potential implications on bone health.
- To examine the role of bone mass acquired during development versus adult bone loss in fracture risk.
Main Methods:
- Review of existing scientific literature on estrogen and progestogen effects on bone.
- Analysis of data concerning bone mineral density (BMD) in relation to age.
- Inclusion of data on new estrogen-free contraceptives, specifically drospirenone-only pills.
Main Results:
- Estrogen inhibits bone resorption by blocking Interleukin-6 (IL-6) synthesis and antagonizing IL-6 receptors.
- Estrogen also influences bone resorption through the OPG/RANKL/RANK system and TNF-α.
- Progestins exhibit varied interactions with androgen, glucocorticoid, and mineralocorticoid receptors, influencing anabolic bone action.
Conclusions:
- Bone mass acquired by the end of the growth period is more critical for fracture risk than adult bone loss.
- Progestin-only contraceptives maintaining estradiol levels between 30-50 pg/mL do not appear to accelerate bone loss.
- Understanding hormonal effects on bone is crucial for evaluating contraceptive options and long-term skeletal health.
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