Oral Contraceptive Use and Fractures Around the Menopausal Transition

项目总结/摘要 在美国，大约有4500万人患有骨质疏松症或低骨量， 1.5每年发生100万例腰椎骨折。妇女承担了不成比例的费用负担， 骨折的后果，部分原因是更年期荷尔蒙的变化增加了骨折的风险。 复方口服避孕药（OC）是美国和世界范围内的主要避孕方法， 目前代表了美国女性最常见的激素外源性暴露。妇女中的使用 由于最近的建议改变，他们的生育年龄可能会增加。而新兴 有证据表明，围绝经期使用OC对骨量有益，目前OC对骨折的影响 配方未知。世界卫生组织最近的一份报告指出，这是一个关键证据， 关于OC使用的获益和风险的差距。 我们提出了一项基于人群的病例对照研究，以评估在晚期使用OC是否 生育年龄（年龄>40岁）与骨折发生的风险有关， 绝经作为评估这种关联的一部分，我们还将探索OC使用的其他模式，如早期 使用和长期使用，以及与这种骨折结果相关的其他因素。病例和对照组（n= 3，400） 将从健康维护组织登记者的特定人群中招募。病例（n= 1，700）将 是45-59岁的女性，在选定的时间点被诊断患有医生裁定的偶发骨折， 解剖部位对照组为随机选择的相同数量的年龄相仿的无骨折妇女 健康计划登记数据库里的数据将通过标准化的 电话面试参与者将接受关于OC使用类型和模式的调查， 生育后期;其他OC使用和激素暴露;以及其他骨折风险因素。 从1977年起，计算机化药房数据可作为OC和药物的额外来源 exposure.比较病例和对照组在围绝经期OC使用、近因性、持续时间、 和其他OC暴露模式，以实现研究目的。 肌肉骨骼疾病是老年人残疾的主要原因。即使是微小的变化率 对公共卫生有着重要的影响。在中年使用OC是一个可改变的因素， 这项研究对确定这些药物的风险或益处很重要。项目叙述 骨折率是一个重大的公共卫生问题，在荷尔蒙分泌后， 伴随更年期的变化美国妇女广泛使用口服避孕药（OCs）， 了解这种激素暴露对骨折风险的可能影响至关重要，特别是使用 接近更年期和使用当前类型的OC。即使骨折的微小增加或减少， 从OC的使用可能有重要的意义，临床实践和骨折的公共卫生负担 在更年期及以后的女性中。

PROJECT SUMMARY/ABSTRACT In the U.S., approximately 45 million individuals have osteoporosis or low bone mass, and an estimated 1.5 million osteoporotic fractures occur annually. Women bear a disproportionate burden of the costs and consequences of fracture, in part because the hormonal changes around menopause heighten fracture risk. Combined oral contraceptives (OCs), the leading method of contraception in the U.S. and worldwide, may currently represent the most common hormonal exogenous exposure for U.S. women. Use among women in their later reproductive years may be increasing due to recent changes in recommendations. While emerging evidence suggests benefits to bone mass from perimenopausal OC use, the effects on fracture of present-day OC formulations are unknown. A recent report from the World Health Organization notes this as a key evidence gap regarding the benefits and risks of OC use. We propose a population-based case-control study to evaluate whether OC use during later reproductive years (age >40 years ) is associated with the risk of fractures occurring around the time of menopause. As part of evaluating this association, we will also explore other patterns of OC use, such as early use and long-term use, and other factors associated with this fracture outcome. Cases and controls (n=3,400) will be recruited from a defined population of health maintenance organization enrollees. Cases (n=1,700) will be women 45-59 years of age who are diagnosed with incident physician adjudicated fractures at selected anatomic sites. Controls will be an equal number of age-similar women without fracture, selected randomly from the health plan enrollment databases. Data will be obtained from cases and controls via a standardized telephone-administered interview. Participants will be surveyed regarding types and patterns of OC use during later reproductive life; other OC use and hormonal exposures; and other risk factors for fracture. Computerized pharmacy data are available from 1977 forward as an additional source of OC and medication exposure. Analyses comparing cases and controls with respect to perimenopausal OC use, recency, duration, and other patterns of OC exposure will be conducted to address the study aim. Musculoskeletal disease is the major cause of disability in older persons. Even small changes in the rate of fractures have important public health implications. OC use during middle age is a modifiable factor and this research is important to defining the risks or benefits of these medications. PROJECT NARRATIVE Fracture rates are of great public health concern and disproportionately affect women after the hormonal changes accompanying menopause. The widespread use of oral contraceptives (OCs) by U.S. women makes understanding the possible effects of this hormonal exposure on fracture risk critical, particularly effects of use close to menopause and use of current types of OCs. Even a small increase or decrease in fracture resulting from OC use could have important implications for clinical practice and for the public health burden of fracture in women transitioning through menopause and beyond.