Oral Contraceptive Use and Fractures Around the Menopausal Transition

项目摘要/摘要 在美国，大约有4500万人患有骨质疏松症或骨量减少，据估计 每年发生150万例骨质疏松性骨折。女性承担了不成比例的费用负担， 骨折的后果，部分原因是更年期前后荷尔蒙的变化会增加骨折的风险。 联合口服避孕药(OCS)是美国和世界范围内领先的避孕方法，可能 目前是美国女性最常见的荷尔蒙外源性暴露。在女性中使用 由于最近建议的变化，他们晚年的生育年限可能会增加。在出现的同时 有证据表明，围绝经期使用OC对骨量有好处，对当今OC骨折的影响 配方尚不清楚。世界卫生组织最近的一份报告指出，这是一个关键证据 在使用OC的好处和风险方面存在差距。 我们提出了一项以人群为基础的病例对照研究，以评估OC在后期是否使用 生育年限(40岁)与发生骨折的风险有关。 更年期。作为评估这种关联的一部分，我们还将探索其他使用OC的模式，例如早期 使用和长期使用，以及与此骨折结局相关的其他因素。病例和对照(n=3400) 将从健康维护组织参与者的特定人群中招募。病例(n=1700)将 是否年龄在45-59岁之间的女性被诊断为意外骨折 解剖位置。随机选择同等数量的年龄相仿、无骨折的女性作为对照。 从健康计划登记数据库中。将从病例和对照中通过标准化的 电话面试。将对参与者进行调查，了解使用OC的类型和模式 较晚的生殖生活；其他OC使用和荷尔蒙暴露；以及其他骨折风险因素。 从1977年起，计算机化的药房数据可以作为OC和药物的另一个来源 曝光。对围绝经期口服避孕药的使用情况、近期情况、持续时间、 为了达到研究目的，还将进行其他形式的OC暴露。 肌肉骨骼疾病是老年人残疾的主要原因。即使是利率的微小变化 骨折的风险具有重要的公共卫生影响。中年期间使用OC是一个可修改的因素， 这项研究对于确定这些药物的风险或好处很重要。项目叙事 骨折发生率是公共卫生的重大问题，在服用激素后对女性的影响不成比例。 伴随着更年期的变化。美国女性广泛使用口服避孕药(OCS)使 了解这种荷尔蒙暴露对骨折风险的可能影响至关重要，特别是使用的影响 接近更年期和使用当前类型的接触网。即使骨折的轻微增加或减少也会导致 OC的使用可能会对临床实践和骨折的公共健康负担产生重要影响 在更年期及更年期以后的女性中。

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.