Hormonal contraceptive use is associated with altered bone structural and metabolic responses to military training in women: An observational cohort study

O'Leary, Thomas J., Izard, Rachel M., Tang, Jonathan C. Y. ORCID: https://orcid.org/0000-0001-6305-6333, Fraser, William D. and Greeves, Julie P. (2024) Hormonal contraceptive use is associated with altered bone structural and metabolic responses to military training in women: An observational cohort study. Bone, 181. ISSN 8756-3282

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Military training increases tibial density and size. Female sex hormones may influence the adaption of bone to loading, but it is unknown if women using different hormonal contraceptives adapt similarly to military training. One hundred and sixteen women (57 women not using hormonal contraceptives [non-users], 38 combined oral contraceptive pill [COCP] users, 21 depot medroxyprogesterone acetate [DMPA] users) completed this study. Tibial volumetric bone mineral density (vBMD) and geometry were measured by peripheral quantitative computed tomography (4 %, 14 %, 38 %, and 66 % sites) at the start (week 1) and end (week 14) of British Army basic training. Circulating markers of bone and calcium metabolism were measured at weeks 1, 2, 4, 6, 10, and 14. Training increased trabecular vBMD at the 4 % site, periosteal perimeter at the 14 % and 66 % sites, and total area, cortical area, cortical thickness, and bone strength at all sites (0.1 to 1.6 %, p ≤ 0.009), with no differences between hormonal contraceptive groups (p ≥ 0.127). Trabecular vBMD increased at the 14 % site in non-users (0.8 %, p = 0.005), but not in COCP or DMPA users (p ≥ 0.205). Periosteal perimeter increased at the 38 % site in COCP (0.4 %, p < 0.001) and DMPA (0.5 %, p < 0.001) users, but not in non-users (p = 0.058). Training had no effect on periosteal perimeter at the 4 % site or cortical vBMD or endosteal perimeter at any site (p ≥ 0.168). βCTX decreased and PINP increased during training with no difference between hormonal contraceptive groups. Training increased iPTH in non-users, but not COCP or DMPA users. Hormonal contraceptives may exert site-specific effects on the mechanobiology of bone, with higher endogenous oestradiol promoting trabecularisation and inhibiting periosteal expansion in non-users compared with hormonal contraceptive users.

Item Type: Article
Additional Information: Data availability: Data will be made available on request. Funding information: This study was funded by the UK Ministry of Defence (Army).
Uncontrolled Keywords: bone modeling and remodelling,bone turnover,exercise,sex steroids,stress fracture,pqct,endocrinology, diabetes and metabolism,physiology,histology ,/dk/atira/pure/subjectarea/asjc/2700/2712
Faculty \ School: Faculty of Medicine and Health Sciences > Norwich Medical School
UEA Research Groups: Faculty of Medicine and Health Sciences > Research Centres > Metabolic Health
Faculty of Medicine and Health Sciences > Research Groups > Musculoskeletal Medicine
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Depositing User: LivePure Connector
Date Deposited: 17 Jan 2024 01:37
Last Modified: 04 Mar 2024 18:25
URI: https://ueaeprints.uea.ac.uk/id/eprint/94193
DOI: 10.1016/j.bone.2024.117012


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