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Hormonal contraceptive use, bone density and biochemical markers of bone metabolism in British Army recruits
  1. Charlotte V Coombs1,
  2. T J O'Leary1,
  3. J C Y Tang2,
  4. W D Fraser2,3 and
  5. J P Greeves1,2
  1. 1Army Health and Performance Research, British Army, Andover, UK
  2. 2Norwich Medical School, University of East Anglia, Norwich, UK
  3. 3Departments of Endocrinology and Clinical Biochemistry, Norfolk and Norwich University Hospital, Norwich, UK
  1. Correspondence to Professor J P Greeves, Army Health and Performance Research, British Army, Andover SP11 8HT, UK; Julie.Greeves143{at}


Introduction Hormonal contraceptive use might impair bone health and increase the risk of stress fracture by decreasing endogenous oestrogen production, a central regulator of bone metabolism. This cross-sectional study investigated bone density and biochemical markers of bone metabolism in women taking hormonal contraceptives on entry to basic military training.

Methods Forty-five female British Army recruits had biochemical markers of bone metabolism, areal bone mineral density (aBMD) and tibial speed of sound (tSOS) measured at the start of basic military training. Participants were compared by their method of hormonal contraception: no hormonal contraception (NONE), combined contraceptive pill (CP) or depot-medroxyprogesterone acetate (DMPA) (20±2.8 years, 1.64±0.63 m, 61.7±6.2 kg).

Results aBMD was not different between groups (p≥0.204), but tSOS was higher in NONE (3%, p=0.014) when compared with DMPA users. Beta C-terminal telopeptide was higher in NONE (45%, p=0.037) and DMPA users (90%, p=0.003) compared with CP users. Procollagen type 1 N-terminal propeptide was higher in DMPA users compared with NONE (43%, p=0.045) and CP users (127%, p=0.001), and higher in NONE compared with CP users (59%, p=0.014). Bone alkaline phosphatase was higher in DMPA users compared with CP users (56%, p=0.044).

Conclusions DMPA use was associated with increased bone turnover and decreased cortical bone integrity of the tibia. Lower cortical bone integrity in DMPA users was possibly mediated by increased intracortical remodelling, but trabecular bone was not affected by contraceptive use.

  • physiology
  • calcium & bone
  • general endocrinology
  • sex steroids & HRT
  • bone diseases

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  • Contributors JPG designed and conducted the study. JCYT and WDF performed the biochemical analysis. CVC performed the data analysis. CVC and TJOL produced the manuscript. All authors edited the manuscript for intellectual content and approved the final version. CVC and JPG take responsibility as guarantors for the overall manuscript content.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The study was approved by the QinetiQ Ethics Committee (QinetiQ SP619).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request.

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