Laura K. Bachrach

Publication Details

  • The effect of oral contraceptives on bone mass and stress fractures in female runners MEDICINE AND SCIENCE IN SPORTS AND EXERCISE Cobb, K. L., Bachrach, L. K., Sowers, M., Nieves, J., Greendale, G. A., Kent, K. K., Brown, B. W., Pettit, K., Harper, D. M., Kelsey, J. L. 2007; 39 (9): 1464-1473


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

    View details for DOI 10.1249/mss.0b013e318074e352

    View details for Web of Science ID 000249445700004

    View details for PubMedID 17805075

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