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Li HJ, Esencan E, Song Y, Taylor HS, Cho Y, Vash-Margita A. Medical Management of Endometriosis in Adolescent and Young Adult Women: A Review of 91 Cases of Biopsy-Confirmed Endometriosis. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2024; 46:102562. [PMID: 38759792 DOI: 10.1016/j.jogc.2024.102562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 04/10/2024] [Accepted: 04/24/2024] [Indexed: 05/19/2024]
Abstract
OBJECTIVES To characterise contemporary trends in the hormonal management of endometriosis in adolescent and young adult patients with biopsy-proven endometriosis. METHODS Retrospective chart review of women aged 14-25 years who underwent laparoscopy for pelvic pain with biopsy-proven endometriosis between January 2011 and September 2020 at an academic tertiary hospital system. The final sample included 91 patients with biopsy-confirmed endometriosis. RESULTS Combined oral contraceptives (COCs) were the most common initial treatment (64% of patients). Progestin-only formulations (low- and high-dose norethindrone acetate) were offered to younger patients (age 15.9 ± 2.7 years) than those offered COCs (19.9 ± 3.3 years) and levonorgestrel intrauterine devices (LNG-IUDs) (21.9 ± 1.7 years). Current treatments varied widely and included COCs (32%), LNG-IUDs (18%), oral progestins (low- and high-dose norethindrone, medroxyprogesterone) (14%), elagolix (9%), and leuprolide (8%). Oral adjuncts to LNG-IUD were common: usually low- or high-dose norethindrone (37% of patients with an LNG-IUD), but also included progesterone, COCs, and elagolix. CONCLUSIONS Oral progestins, LNG-IUDs, and COCs were the mainstay of initial treatment. Subsequent treatments varied widely and included COCs, LNG-IUDs, oral progestins, elagolix, leuprolide, and combinations of these agents. We observed that most young women switched between therapies, suggesting that a personalised approach is often used to determine treatment plans among the wide range of options currently available. This study helps define the spectrum of treatment regimens for endometriosis in adolescent females.
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Affiliation(s)
- Howard J Li
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, CT, USA
| | - Ecem Esencan
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, CT, USA
| | - Yue Song
- Yale School of Public Health, Yale University, New Haven, CT, USA; Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, CA, USA
| | - Hugh S Taylor
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, CT, USA
| | - Yonghee Cho
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, CT, USA
| | - Alla Vash-Margita
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, CT, USA.
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Boogers LS, van der Loos MATC, Wiepjes CM, van Trotsenburg ASP, den Heijer M, Hannema SE. The dose-dependent effect of estrogen on bone mineral density in trans girls. Eur J Endocrinol 2023; 189:290-296. [PMID: 37590955 DOI: 10.1093/ejendo/lvad116] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 07/20/2023] [Accepted: 07/26/2023] [Indexed: 08/19/2023]
Abstract
OBJECTIVE Treatment in transgender girls can consist of puberty suppression (PS) with a gonadotropin-releasing hormone agonist (GnRHa) followed by gender-affirming hormonal treatment (GAHT) with estrogen. Bone mineral density (BMD) Z-scores decrease during PS and remain relatively low during GAHT, possibly due to insufficient estradiol dosage. Some adolescents receive high-dose estradiol or ethinyl estradiol (EE) to limit growth allowing comparison of BMD outcomes with different dosages. DESIGN Retrospective study. METHODS Adolescents treated with GnRHa for ≥1 year prior to GAHT followed by treatment with a regular estradiol dose (gradually increased to 2 mg), 6 mg estradiol or 100-200 µg EE were included to evaluate height-adjusted BMD Z-scores (HAZ scores) on DXA. RESULTS Eighty-seven adolescents were included. During 2.3 ± 0.7 years PS, lumbar spine HAZ scores decreased by 0.69 [95% confidence interval (CI) -0.82 to -0.56)]. During 2 years HT, lumbar spine HAZ scores hardly increased in the regular group (0.14, 95% CI -0.01 to 0.28, n = 59) vs 0.42 (95% CI 0.13 to 0.72) in the 6 mg group (n = 13), and 0.68 (95% CI 0.20 to 1.15) in the EE group (n = 15). Compared with the regular group, the increase with EE treatment was higher (0.54, 95% CI 0.05 to 1.04). After 2 years HT, HAZ scores approached baseline levels at start of PS in individuals treated with 6 mg or EE (difference in 6 mg group -0.20, 95% CI -0.50 to 0.09; in EE 0.17, 95% CI -0.16 to 0.50) but not in the regular group (-0.64, 95% CI -0.79 to -0.49). CONCLUSION Higher estrogen dosage is associated with a greater increase in lumbar spine BMD Z-scores. Increasing dosage up to 2 mg estradiol is insufficient to optimize BMD and approximately 4 mg may be required for adequate serum concentrations.
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Affiliation(s)
- Lidewij Sophia Boogers
- Department of Pediatric Endocrinology, Center of Expertise on Gender Dysphoria, Amsterdam UMC Location Vrije Universiteit, 1081 HZ, Amsterdam, The Netherlands
- Department of Endocrinology and Metabolism, Center of Expertise on Gender Dysphoria, Amsterdam UMC Location Vrije Universiteit, 1081 HZ, Amsterdam, The Netherlands
- Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands
| | - Maria Anna Theodora Catharina van der Loos
- Department of Endocrinology and Metabolism, Center of Expertise on Gender Dysphoria, Amsterdam UMC Location Vrije Universiteit, 1081 HZ, Amsterdam, The Netherlands
- Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands
| | - Chantal Maria Wiepjes
- Department of Endocrinology and Metabolism, Center of Expertise on Gender Dysphoria, Amsterdam UMC Location Vrije Universiteit, 1081 HZ, Amsterdam, The Netherlands
- Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands
| | - Adrianus Sarinus Paulus van Trotsenburg
- Department of Pediatric Endocrinology, Center of Expertise on Gender Dysphoria, Amsterdam UMC Location Vrije Universiteit, 1081 HZ, Amsterdam, The Netherlands
- Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands
| | - Martin den Heijer
- Department of Endocrinology and Metabolism, Center of Expertise on Gender Dysphoria, Amsterdam UMC Location Vrije Universiteit, 1081 HZ, Amsterdam, The Netherlands
- Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands
| | - Sabine Elisabeth Hannema
- Department of Pediatric Endocrinology, Center of Expertise on Gender Dysphoria, Amsterdam UMC Location Vrije Universiteit, 1081 HZ, Amsterdam, The Netherlands
- Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development, Amsterdam, The Netherlands
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3
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Hollingshead N, Hodax JK, Boos MD. Management of acne in transgender and gender diverse youth Part 2: Unique considerations and strategies in medical treatment. Pediatr Dermatol 2022; 39:870-875. [PMID: 35973559 DOI: 10.1111/pde.15114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 07/31/2022] [Indexed: 11/28/2022]
Abstract
Acne vulgaris is among the most common skin disorders afflicting adolescents worldwide, and though well-established guidelines of care exist for acne management, these guidelines do not uniformly consider or address the unique psychosocial and medical needs of transgender and gender diverse (TGD) youth. Part 2 of this two-part review provides guidance on a stepwise approach to the medical treatment of acne in TGD youth, with an emphasis on safety, efficacy, and the delivery of medical care in a culturally humble, thoughtful, and gender-affirming manner.
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Affiliation(s)
| | - Juanita K Hodax
- Division of Endocrinology, Department of Pediatrics, University of Washington School of Medicine and Seattle Children's Hospital, Seattle, Washington, USA
| | - Markus D Boos
- Division of Dermatology, Department of Pediatrics, University of Washington School of Medicine and Seattle Children's Hospital, Seattle, Washington, USA
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4
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Caldeirão TD, Orsolini LR, da Silva CC, Bisi Rizzo ADC, Teixeira AS, Nunes HRDC, Goldberg TBL. Effect of two combinations of low-dose oral contraceptives on adolescent bone mass: A clinical trial with 2 years follow-up. Medicine (Baltimore) 2022; 101:e30680. [PMID: 36123858 PMCID: PMC9478298 DOI: 10.1097/md.0000000000030680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 08/22/2022] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Most contraceptive combinations can interfere with the processes of bone formation and resorption. AIM The aim of this study was to evaluate the effect of 2 combinations of low-dose oral hormonal contraceptives (20 µg ethinyl estradiol [EE]/150 mg desogestrel [COC1] or 30 µg EE/3 mg drospirenone [COC2]) on bone mass acquisition in adolescents over 2 years by means of bone densitometry and measurement of biomarkers of bone remodeling. METHODS Parallel-group, non-randomized controlled clinical trial of 127 adolescents divided into a control group and 2 groups receiving either COC1 or COC2. The participants were submitted to anthropometric assessment and evaluation of secondary sexual characteristics (Tanner criteria) and bone age. Bone densitometry by dual-energy X-ray absorptiometry and measurement of bone biomarkers (bone alkaline phosphatase, osteocalcin, and C-terminal telopeptide) were performed at baseline and after 24 months. RESULTS No significant differences in the variables analyzed were observed between COC1 or COC2 users and the control group at baseline. After 24 months, non-users had incorporated more bone mass (content and density) than either group of contraceptive users. This negative impact was more pronounced in the COC2 group than in the COC1 group. A significant reduction in the percentage values of bone alkaline phosphatase and osteocalcin was observed in users of oral contraceptives. CONCLUSION Bone mass acquisition was compromised in adolescent users of combined hormonal contraceptives. The negative impact was more pronounced in adolescents using contraceptives that contain 30 µg EE/3 mg drospirenone.
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Affiliation(s)
- Talita Domingues Caldeirão
- Postgraduate Program in Tocogynecology, Botucatu Medical School, São Paulo State University (UNESP), Botucatu, São Paulo, Brazil
- Medical School, Assis Municipality Educational Foundation (FEMA), Assis, SP, Brazil
| | - Lilian Rodrigues Orsolini
- Postgraduate Program in Tocogynecology, Botucatu Medical School, São Paulo State University (UNESP), Botucatu, São Paulo, Brazil
- Medical School, Assis Municipality Educational Foundation (FEMA), Assis, SP, Brazil
| | | | - Anapaula da Conceição Bisi Rizzo
- Postgraduate Program in Tocogynecology, Botucatu Medical School, São Paulo State University (UNESP), Botucatu, São Paulo, Brazil
| | - Altamir Santos Teixeira
- Department of Tropical Diseases and Diagnostic Imaging, Botucatu Medical School, São Paulo University (UNESP), Botucatu, São Paulo, Brazil
| | | | - Tamara Beres Lederer Goldberg
- Postgraduate Program in Tocogynecology, Botucatu Medical School, São Paulo State University (UNESP), Botucatu, São Paulo, Brazil
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Svoboda RM, Nawaz N, Zaenglein AL. Hormonal Treatment of Acne and Hidradenitis Suppurativa in Adolescent Patients. Dermatol Clin 2022; 40:167-178. [DOI: 10.1016/j.det.2021.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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6
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d’Angelo DM, Di Donato G, Breda L, Chiarelli F. Growth and puberty in children with juvenile idiopathic arthritis. Pediatr Rheumatol Online J 2021; 19:28. [PMID: 33712046 PMCID: PMC7953722 DOI: 10.1186/s12969-021-00521-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 03/04/2021] [Indexed: 12/13/2022] Open
Abstract
Juvenile Idiopathic Arthritis is one of the most prevalent chronic diseases in children, with an annual incidence of 2-20 cases per 100,000 and a prevalence of 16-150 per 100,000. It is associated with several complications that can cause short-term or long-term disability and reduce the quality of life. Among these, growth and pubertal disorders play an important role. Chronic inflammatory conditions are often associated with growth failure ranging from slight decrease in height velocity to severe forms of short stature. The prevalence of short stature in JIA varies from 10.4% in children with polyarticular disease to 41% of patients with the systemic form, while oligoarthritis is mostly associated with localized excessive bone growth of the affected limb, leading to limb dissymmetry. The pathogenesis of growth disorders is multifactorial and includes the role of chronic inflammation, long-term use of corticosteroids, undernutrition, altered body composition, delay of pubertal onset or slow pubertal progression. These factors can exert a systemic effect on the GH/IGF-1 axis and on the GnRH-gonadotropin-gonadic axis, or a local influence on the growth plate homeostasis and function. Although new therapeutic options are available to control inflammation, there are still 10-20% of patients with severe forms of the disease who show continuous growth impairment, ending in a short final stature. Moreover, delayed puberty is associated with a reduction in the peak bone mass with the possibility of concomitant or future bone fragility. Monitoring of puberty and bone health is essential for a complete health assessment of adolescents with JIA. In these patients, an assessment of the pubertal stage every 6 months from the age of 9 years is recommended. Also, linear growth should be always evaluated considering the patient's bone age. The impact of rhGH therapy in children with JIA is still unclear, but it has been shown that if rhGH is added at high dose in a low-inflammatory condition, post steroids and on biologic therapy, it is able to favor a prepubertal growth acceleration, comparable with the catch-up growth response in GH-deficient patients. Here we provide a comprehensive review of the pathogenesis of puberty and growth disorders in children with JIA, which can help the pediatrician to properly and timely assess the presence of growth and pubertal disorders in JIA patients.
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Affiliation(s)
| | - Giulia Di Donato
- grid.412451.70000 0001 2181 4941Department of Pediatrics, University of Chieti, Chieti, Italy
| | - Luciana Breda
- grid.412451.70000 0001 2181 4941Department of Pediatrics, University of Chieti, Chieti, Italy
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Golden NH. Bones and Birth Control in Adolescent Girls. J Pediatr Adolesc Gynecol 2020; 33:249-254. [PMID: 31972296 DOI: 10.1016/j.jpag.2020.01.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 01/07/2020] [Accepted: 01/11/2020] [Indexed: 12/24/2022]
Abstract
Peak bone mass acquisition during adolescence is an important determinant of adult bone health. Knowledge about the effects of different contraceptives on peak bone mass acquisition could influence choice of method recommended. This review summarizes normal bone acquisition during adolescence, discusses methods of assessing bone health in this age group, and reviews the effects of different contraceptive options on bone health, both in adults and in adolescents. Based on the evidence, long-acting reversible contraceptives do not appear to affect peak bone mass acquisition or future fracture risk and remain the first-line contraceptive choice for adolescents. Oral contraceptives with doses of ethinyl estradiol greater than 30 μg should be used in preference to lower-dose preparations, and the adverse effects of depo medroxyprogesterone acetate (DMPA) on bone health are reversible on discontinuation of the medication. Concerns about bone health should not prevent use of DMPA in an adolescent who prefers this method.
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Affiliation(s)
- Neville H Golden
- Lucile Packard Children's Hospital, Stanford, Stanford University School of Medicine, Palo Alto, California.
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8
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Kontrazeptionsbeginn in der Pubertät – wann, wie, womit? Monatsschr Kinderheilkd 2019. [DOI: 10.1007/s00112-019-00775-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Zusammenfassung
Während der Pubertät stellen sich Mädchen in der Praxis oft mit Fragen bezüglich und dem Wunsch nach einer Verhütung vor. Diese Beratung ist eine besondere Herausforderung, da gerade in der Adoleszenz die zuverlässige Kontrazeption zur Vermeidung ungewollter Schwangerschaften sehr wichtig ist und die Jugendlichen durch Nebenwirkungen der Kontrazeptiva nicht verunsichert werden sollten. Dennoch ist es aus medizinischer Sicht obligat, Kontraindikationen wie beispielsweise ein erhöhtes Thromboserisiko oder Wechselwirkungen mit einer bestehenden Medikation abzuklären, um dann gemeinsam mit der Jugendlichen ein geeignetes Kontrazeptivum auszuwählen. Neben der am häufigsten verwendeten Verhütungsmethode in der Adoleszenz – kombinierte Hormonpräparate, auch ggf. im Langzyklus – sollten die Mädchen umfassend über Barrieremethoden, insbesondere über den zusätzlichen Gebrauch von Kondomen zum Schutz vor Geschlechtskrankheiten, über Notfallkontrazeption und über lang wirksame kontrazeptive Maßnahmen informiert werden.
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9
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Rizzo ADCB, Goldberg TBL, Biason TP, Kurokawa CS, Silva CCD, Corrente JE, Nunes HRC. One-year adolescent bone mineral density and bone formation marker changes through the use or lack of use of combined hormonal contraceptives. J Pediatr (Rio J) 2019; 95:567-574. [PMID: 29959901 DOI: 10.1016/j.jped.2018.05.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 05/03/2018] [Accepted: 05/03/2018] [Indexed: 10/28/2022] Open
Abstract
OBJECTIVE The objective of this study was to evaluate the effects of two low-dose combined oral contraceptives on bone metabolism in adolescents for one year. METHODS This was a quasi-experimental study. The adolescents were divided into three groups: oral contraceptives 1 (n=42) (20μg EE/150μg desogestrel), oral contraceptives 2 (n=66) (30μg EE/3mg drospirenone), and a control group (n=70). Adolescents underwent anthropometric assessment and densitometry (dual-energy X-ray). Bone age and bone formation markers (osteocalcin and bone alkaline phosphatase) were evaluated. The oral contraceptives users were evaluated again after 12 months. Linear regression analysis was used to indirectly study the effect of each additional year of chronological age on anthropometric and densitometric variables as well as on bone markers in the control group. RESULTS At study entry, no significant differences were observed between the oral contraceptives 1, oral contraceptives 2, and controls in the analyzed variables. Linear regression analysis showed an increase in bone mineral density and bone mineral content for each additional year. There was a significant reduction in bone alkaline phosphatase levels; no significant difference was observed for osteocalcin in control individuals. Comparison of dual-energy X-ray variables at baseline and after one year showed no significant differences in the oral contraceptives 1 or oral contraceptives 2 groups. A significant reduction in bone alkaline phosphatase and osteocalcin levels was observed in both the oral contraceptives 1 and oral contraceptives 2 groups. CONCLUSION Adolescent women gain peak bone mass during this phase of life. Two low-dose combined oral hormonal contraceptives were associated with lower bone gain and lower bone formation markers than in untreated controls.
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Affiliation(s)
- Anapaula da Conceição Bisi Rizzo
- Universidade Estadual Paulista (UNESP), Faculdade de Medicina de Botucatu, Departamento de Pediatria, Programa de Pós-graduação em Ginecologia, Obstetrícia e Mastologia, Botucatu, SP, Brazil
| | - Tamara Beres Lederer Goldberg
- Universidade Estadual Paulista (UNESP), Faculdade de Medicina de Botucatu, Departamento de Pediatria, Programa de Pós-graduação em Ginecologia, Obstetrícia e Mastologia, Botucatu, SP, Brazil.
| | - Talita Poli Biason
- Universidade Estadual Paulista (UNESP), Faculdade de Medicina de Botucatu, Departamento de Pediatria, Programa de Pós-graduação em Ginecologia, Obstetrícia e Mastologia, Botucatu, SP, Brazil
| | - Cilmery Suemi Kurokawa
- Universidade Estadual Paulista (UNESP), Faculdade de Medicina de Botucatu, Departamento de Pediatria, Centro de Pesquisa Pediátrica Clínica e Experimental, Botucatu, SP, Brazil
| | | | - José Eduardo Corrente
- Universidade Estadual Paulista (UNESP), Instituto de Biociências, Departamento de Estatística, Botucatu, SP, Brazil
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10
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Rizzo ADCB, Goldberg TBL, Biason TP, Kurokawa CS, Silva CCD, Corrente JE, Nunes HRC. One‐year adolescent bone mineral density and bone formation marker changes through the use or lack of use of combined hormonal contraceptives. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2019. [DOI: 10.1016/j.jpedp.2018.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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11
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Christin-Maitre S. Use of Hormone Replacement in Females with Endocrine Disorders. Horm Res Paediatr 2018; 87:215-223. [PMID: 28376481 DOI: 10.1159/000457125] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 01/18/2017] [Indexed: 12/16/2022] Open
Abstract
Hormone replacement therapy (HRT) is necessary in adolescents with primary ovarian insufficiency (POI) in order to avoid estrogen deficiency. The goal of this minirewiew is to present the different types of estrogens (17β-estradiol, estradiol valerate, ethinyl estradiol, and combined equine estrogens) as well as the different types of progestins available. In order to choose among the different types of HRTs, the features of each regimen are being discussed as well as their risks and their respective benefits. The differences between oral combined contraceptive pills and a dissociated regimen containing estrogen and progestins are emphasized. The different effects of HRTs, mainly on feminization, growth spurt, bone mass as well as cardiovascular risk, and the follow-up of these young patients are presented. HRT in adolescents and young adults with estrogen deficiency is necessary and should be continued until the age of natural menopause. Studies have so far essentially included children or adolescents with Turner syndrome. Therefore, studies on HRT including patients with POI and a normal karyotype are necessary.
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12
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Lorsch ZS, Loh YHE, Purushothaman I, Walker DM, Parise EM, Salery M, Cahill ME, Hodes GE, Pfau ML, Kronman H, Hamilton PJ, Issler O, Labonté B, Symonds AE, Zucker M, Zhang TY, Meaney MJ, Russo SJ, Shen L, Bagot RC, Nestler EJ. Estrogen receptor α drives pro-resilient transcription in mouse models of depression. Nat Commun 2018; 9:1116. [PMID: 29549264 PMCID: PMC5856766 DOI: 10.1038/s41467-018-03567-4] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 02/22/2018] [Indexed: 11/30/2022] Open
Abstract
Most people exposed to stress do not develop depression. Animal models have shown that stress resilience is an active state that requires broad transcriptional adaptations, but how this homeostatic process is regulated remains poorly understood. In this study, we analyze upstream regulators of genes differentially expressed after chronic social defeat stress. We identify estrogen receptor α (ERα) as the top regulator of pro-resilient transcriptional changes in the nucleus accumbens (NAc), a key brain reward region implicated in depression. In accordance with these findings, nuclear ERα protein levels are altered by stress in male and female mice. Further, overexpression of ERα in the NAc promotes stress resilience in both sexes. Subsequent RNA-sequencing reveals that ERα overexpression in NAc reproduces the transcriptional signature of resilience in male, but not female, mice. These results indicate that NAc ERα is an important regulator of pro-resilient transcriptional changes, but with sex-specific downstream targets.
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Affiliation(s)
- Zachary S Lorsch
- Fishberg Department of Neuroscience, Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, 1 Gustave L Levy Place, New York, NY, 10029, USA
| | - Yong-Hwee Eddie Loh
- Fishberg Department of Neuroscience, Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, 1 Gustave L Levy Place, New York, NY, 10029, USA
| | - Immanuel Purushothaman
- Fishberg Department of Neuroscience, Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, 1 Gustave L Levy Place, New York, NY, 10029, USA
| | - Deena M Walker
- Fishberg Department of Neuroscience, Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, 1 Gustave L Levy Place, New York, NY, 10029, USA
| | - Eric M Parise
- Fishberg Department of Neuroscience, Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, 1 Gustave L Levy Place, New York, NY, 10029, USA
| | - Marine Salery
- Fishberg Department of Neuroscience, Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, 1 Gustave L Levy Place, New York, NY, 10029, USA
| | - Michael E Cahill
- Department of Comparative Biosciences, University of Wisconsin-Madison, Madison, WI, 53706, USA
| | - Georgia E Hodes
- School of Neuroscience, Virginia Polytechnic Institute and State University, 1981 Kraft Drive, Blacksburg, VA, 24061, USA
| | - Madeline L Pfau
- Fishberg Department of Neuroscience, Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, 1 Gustave L Levy Place, New York, NY, 10029, USA
| | - Hope Kronman
- Fishberg Department of Neuroscience, Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, 1 Gustave L Levy Place, New York, NY, 10029, USA
| | - Peter J Hamilton
- Fishberg Department of Neuroscience, Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, 1 Gustave L Levy Place, New York, NY, 10029, USA
| | - Orna Issler
- Fishberg Department of Neuroscience, Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, 1 Gustave L Levy Place, New York, NY, 10029, USA
| | - Benoit Labonté
- Department of Neuroscience and Psychiatry, Faculty of Medicine, Laval University, 2601 Chemin de la Canardière Québec, QC, G1J 2G3, Canada
| | - Ann E Symonds
- Fishberg Department of Neuroscience, Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, 1 Gustave L Levy Place, New York, NY, 10029, USA
| | - Matthew Zucker
- Fishberg Department of Neuroscience, Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, 1 Gustave L Levy Place, New York, NY, 10029, USA
| | - Tie Yuan Zhang
- Ludmer Centre for Neuroinformatics and Mental Health, Douglas Institute, Sackler Program for Epigenetics and Psychobiology, Departments of Psychiatry and Neurology and Neurosurgery, McGill University, 6875 Boulevard Lasalle, Montréal, QC, H4H 1R3, Canada
| | - Michael J Meaney
- Ludmer Centre for Neuroinformatics and Mental Health, Douglas Institute, Sackler Program for Epigenetics and Psychobiology, Departments of Psychiatry and Neurology and Neurosurgery, McGill University, 6875 Boulevard Lasalle, Montréal, QC, H4H 1R3, Canada
| | - Scott J Russo
- Fishberg Department of Neuroscience, Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, 1 Gustave L Levy Place, New York, NY, 10029, USA
| | - Li Shen
- Fishberg Department of Neuroscience, Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, 1 Gustave L Levy Place, New York, NY, 10029, USA
| | - Rosemary C Bagot
- Departments of Psychology & Psychiatry, Ludmer Centre for Neuroinformatics and Mental Health, McGill University, 1205 Avenue Dr Penfield, Montréal, QC, H3A 1B1, Canada
| | - Eric J Nestler
- Fishberg Department of Neuroscience, Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, 1 Gustave L Levy Place, New York, NY, 10029, USA.
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The Efficacy of Postoperative Cyclic Oral Contraceptives after Gonadotropin-Releasing Hormone Agonist Therapy to Prevent Endometrioma Recurrence in Adolescents. J Pediatr Adolesc Gynecol 2017; 30:223-227. [PMID: 27744096 DOI: 10.1016/j.jpag.2016.10.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Revised: 08/31/2016] [Accepted: 10/04/2016] [Indexed: 01/24/2023]
Abstract
STUDY OBJECTIVE Young age is a possible risk factor of endometriosis recurrence after surgery. However, the efficacy of postoperative medical treatment has not been well addressed in adolescents. The purpose of this study was to evaluate whether postoperative medical treatment is as effective in adolescents as it is in adults in the prevention of endometrioma recurrence. DESIGN A retrospective cohort study. SETTING Samsung Medical Center, Seoul, Korea. PARTICIPANTS This study included 176 reproductive-aged women who underwent conservative laparoscopic surgery for pathology-confirmed endometrioma. Women were classified into 2 groups according to age: adolescents (20 years of age and younger, n = 34; group I) and reproductive-aged women (aged 25-35 years, n = 142; group II). INTERVENTIONS The same surgeon performed all of the surgeries for uniformity. Postoperatively, patients were treated monthly with a gonadotropin-releasing hormone agonist depot for 3-6 months, followed by cyclic oral contraceptives. MAIN OUTCOME MEASURES Endometrioma recurrence was determined using ultrasonography. The recurrence rate of endometrioma was compared between the 2 groups. RESULTS During the treatment period (median, 41.0 months; range, 6-159 months), recurrence was noted in 8 cases (4.5%). After adjusting for confounders (which were statistically different between the groups), the cumulative proportion of recurrent endometriomas after 60 months was comparable between the 2 groups (5.3% in group I and 8.5% in group II). CONCLUSION Long-term postoperative medical treatment with cyclic oral contraceptives after a gonadotropin-releasing hormone agonist can be as effective in adolescents as it is in adults in the prevention of endometrioma recurrence.
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14
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Gordon CM, Zemel BS, Wren TAL, Leonard MB, Bachrach LK, Rauch F, Gilsanz V, Rosen CJ, Winer KK. The Determinants of Peak Bone Mass. J Pediatr 2017; 180:261-269. [PMID: 27816219 DOI: 10.1016/j.jpeds.2016.09.056] [Citation(s) in RCA: 113] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 08/19/2016] [Accepted: 09/26/2016] [Indexed: 02/07/2023]
Affiliation(s)
- Catherine M Gordon
- Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH.
| | - Babette S Zemel
- Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA
| | - Tishya A L Wren
- Children's Hospital Los Angeles, University of Southern California, Los Angeles, CA
| | | | | | - Frank Rauch
- Shriners Hospital for Children, McGill University, Montreal, Canada
| | - Vicente Gilsanz
- Children's Hospital Los Angeles, University of Southern California, Los Angeles, CA
| | | | - Karen K Winer
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD
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15
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Eating disorders in children and adolescents: what does the gynecologist need to know? Curr Opin Obstet Gynecol 2016; 28:381-92. [DOI: 10.1097/gco.0000000000000317] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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16
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Weaver CM, Gordon CM, Janz KF, Kalkwarf HJ, Lappe JM, Lewis R, O'Karma M, Wallace TC, Zemel BS. The National Osteoporosis Foundation's position statement on peak bone mass development and lifestyle factors: a systematic review and implementation recommendations. Osteoporos Int 2016; 27:1281-1386. [PMID: 26856587 PMCID: PMC4791473 DOI: 10.1007/s00198-015-3440-3] [Citation(s) in RCA: 747] [Impact Index Per Article: 93.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Accepted: 11/10/2015] [Indexed: 12/21/2022]
Abstract
Lifestyle choices influence 20-40 % of adult peak bone mass. Therefore, optimization of lifestyle factors known to influence peak bone mass and strength is an important strategy aimed at reducing risk of osteoporosis or low bone mass later in life. The National Osteoporosis Foundation has issued this scientific statement to provide evidence-based guidance and a national implementation strategy for the purpose of helping individuals achieve maximal peak bone mass early in life. In this scientific statement, we (1) report the results of an evidence-based review of the literature since 2000 on factors that influence achieving the full genetic potential for skeletal mass; (2) recommend lifestyle choices that promote maximal bone health throughout the lifespan; (3) outline a research agenda to address current gaps; and (4) identify implementation strategies. We conducted a systematic review of the role of individual nutrients, food patterns, special issues, contraceptives, and physical activity on bone mass and strength development in youth. An evidence grading system was applied to describe the strength of available evidence on these individual modifiable lifestyle factors that may (or may not) influence the development of peak bone mass (Table 1). A summary of the grades for each of these factors is given below. We describe the underpinning biology of these relationships as well as other factors for which a systematic review approach was not possible. Articles published since 2000, all of which followed the report by Heaney et al. [1] published in that year, were considered for this scientific statement. This current review is a systematic update of the previous review conducted by the National Osteoporosis Foundation [1]. [Table: see text] Considering the evidence-based literature review, we recommend lifestyle choices that promote maximal bone health from childhood through young to late adolescence and outline a research agenda to address current gaps in knowledge. The best evidence (grade A) is available for positive effects of calcium intake and physical activity, especially during the late childhood and peripubertal years-a critical period for bone accretion. Good evidence is also available for a role of vitamin D and dairy consumption and a detriment of DMPA injections. However, more rigorous trial data on many other lifestyle choices are needed and this need is outlined in our research agenda. Implementation strategies for lifestyle modifications to promote development of peak bone mass and strength within one's genetic potential require a multisectored (i.e., family, schools, healthcare systems) approach.
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Affiliation(s)
- C M Weaver
- Department of Nutritional Sciences, Women's Global Health Institute, Purdue University, 700 W. State Street, West Lafayette, IN, 47907, USA
| | - C M Gordon
- Division of Adolescent and Transition Medicine, Cincinnati Children's Hospital, 3333 Burnet Avenue, MLC 4000, Cincinnati, OH, 45229, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, 3230 Eden Ave, Cincinnati, OH, 45267, USA
| | - K F Janz
- Departments of Health and Human Physiology and Epidemiology, University of Iowa, 130 E FH, Iowa City, IA, 52242, USA
| | - H J Kalkwarf
- Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 7035, Cincinnati, OH, 45229, USA
| | - J M Lappe
- Schools of Nursing and Medicine, Creighton University, 601 N. 30th Street, Omaha, NE, 68131, USA
| | - R Lewis
- Department of Foods and Nutrition, University of Georgia, Dawson Hall, Athens, GA, 30602, USA
| | - M O'Karma
- The Children's Hospital of Philadelphia Research Institute, 3535 Market Street, Room 1560, Philadelphia, PA, 19104, USA
| | - T C Wallace
- Department of Nutrition and Food Studies, George Mason University, MS 1 F8, 10340 Democracy Lane, Fairfax, VA, 22030, USA.
- National Osteoporosis Foundation, 1150 17th Street NW, Suite 850, Washington, DC, 20036, USA.
- National Osteoporosis Foundation, 251 18th Street South, Suite 630, Arlington, VA, 22202, USA.
| | - B S Zemel
- University of Pennsylvania Perelman School of Medicine, 3535 Market Street, Room 1560, Philadelphia, PA, 19104, USA
- Division of Gastroenterology, Hepatology, and Nutrition, The Children's Hospital of Philadelphia, 3535 Market Street, Room 1560, Philadelphia, PA, 19104, USA
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Nieves JW, Ruffing JA, Zion M, Tendy S, Yavorek T, Lindsay R, Cosman F. Eating disorders, menstrual dysfunction, weight change and DMPA use predict bone density change in college-aged women. Bone 2016; 84:113-119. [PMID: 26746778 DOI: 10.1016/j.bone.2015.12.054] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Revised: 12/23/2015] [Accepted: 12/28/2015] [Indexed: 10/22/2022]
Abstract
INTRODUCTION There are limited longitudinal studies that have evaluated bone mineral density (BMD) changes in college-aged women. Our objective was to simultaneously evaluate factors influencing 4-year BMD change. METHODS This was a longitudinal cohort study of healthy, physically active women in the US Military Academy (n=91; average age=18.4years). Assessments over four years included: height, weight, calcium intake, physical fitness, menstrual function (annual number cycles), oral contraceptives (OCs) or depot-medroxyprogesterone acetate (DMPA) use, and eating disorder behavior (Eating Disorder Inventory; (EDI)). BMD was measured annually at the lumbar spine and total hip by dual X-ray absorptiometry and calcaneal BMD by PIXI. Slope of 4year BMD change at each skeletal site (spine total hip and calcaneus) was calculated for each woman. RESULTS BMD gains occurred at the spine in 50% and the hip in 36% of women. In unadjusted analyses, spine bone gain was positively related to menstrual cycle frequency (p=0.04). Spine and hip BMD loss occurred in those using DMPA (p<0.01) and those with the highest EDI quartile scores (p<0.05). BMD change was unrelated to OC use. Hip and calcaneus BMD decreased with weight loss (average 4.8+2.2lb/year) as compared to those with stable weight/weight gain (p<0.05). In multivariable analysis, spine BMD increase was significantly related to African American (AA) race, normal EDI score and normal menses. Hip BMD increase was related to AA race, weight increase and normal menses. DMPA use was associated with spine, hip, and calcaneus bone loss. CONCLUSION On average, BMD may modestly increase in college-aged women, in the absence of risk factors. However, risk factors including subclinical eating disorders, weight loss, menstrual dysfunction and DMPA use can have significant detrimental effects on BMD in young healthy physically active women.
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Affiliation(s)
- Jeri W Nieves
- Clinical Research and Regional Bone Centers, Helen Hayes Hospital, West Haverstraw, NY, USA; Department of Epidemiology, Mailman School of Public Health Columbia University, NY, USA.
| | - Jamie A Ruffing
- Clinical Research and Regional Bone Centers, Helen Hayes Hospital, West Haverstraw, NY, USA; Department of Epidemiology, Mailman School of Public Health Columbia University, NY, USA
| | - Marsha Zion
- Clinical Research and Regional Bone Centers, Helen Hayes Hospital, West Haverstraw, NY, USA
| | - Susan Tendy
- United States Military Academy, West Point, NY, USA
| | | | - Robert Lindsay
- Clinical Research and Regional Bone Centers, Helen Hayes Hospital, West Haverstraw, NY, USA; Department of Medicine, College of Physicians and Surgeons of Columbia University, NY, USA
| | - Felicia Cosman
- Clinical Research and Regional Bone Centers, Helen Hayes Hospital, West Haverstraw, NY, USA; Department of Medicine, College of Physicians and Surgeons of Columbia University, NY, USA
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Abstract
Steroid hormones have been in use for more than a half a century as contraceptive agents, and only now are researchers elucidating the biochemical mechanisms of action and non-target effects. Progesterone and synthetic progestins, critical for women's health in the US and internationally, appear to have important effects on immune functioning and other diverse systems. Apart from the contraceptive world is a separate field that is devoted to understanding progesterone in other contexts. Based on research following a development timeline parallel to hormonal contraception, progesterone and 17-hydroxyprogesterone caproate are now administered to prevent preterm birth in high-risk pregnant women. Preterm birth researchers are similarly working to determine the precise biochemical actions and immunological effects of progesterone. Progesterone research in both areas could benefit from increased collaboration and bringing these two bodies of literature together. Progesterone, through actions on various hormone receptors, has lifelong importance in different organ systems and researchers have much to learn about this molecule from the combination of existing literatures, and from future studies that build on this combined knowledge base.
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Affiliation(s)
- Elizabeth Micks
- Department of Obstetrics and GynecologyUniversity of Washington, Box 356460, 1959 NE Pacific Street, Seattle, Washington, USADepartment of ResearchAmerican College of Obstetricians and Gynecologists, 409 12th Street SW, Washington, District of Columbia, USA
| | - Greta B Raglan
- Department of Obstetrics and GynecologyUniversity of Washington, Box 356460, 1959 NE Pacific Street, Seattle, Washington, USADepartment of ResearchAmerican College of Obstetricians and Gynecologists, 409 12th Street SW, Washington, District of Columbia, USA
| | - Jay Schulkin
- Department of Obstetrics and GynecologyUniversity of Washington, Box 356460, 1959 NE Pacific Street, Seattle, Washington, USADepartment of ResearchAmerican College of Obstetricians and Gynecologists, 409 12th Street SW, Washington, District of Columbia, USA Department of Obstetrics and GynecologyUniversity of Washington, Box 356460, 1959 NE Pacific Street, Seattle, Washington, USADepartment of ResearchAmerican College of Obstetricians and Gynecologists, 409 12th Street SW, Washington, District of Columbia, USA
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Jackowski SA, Baxter-Jones ADG, McLardy AJ, Pierson RA, Rodgers CD. The associations of exposure to combined hormonal contraceptive use on bone mineral content and areal bone mineral density accrual from adolescence to young adulthood: A longitudinal study. Bone Rep 2015; 5:e333-e341. [PMID: 28580404 PMCID: PMC5440951 DOI: 10.1016/j.bonr.2015.06.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Accepted: 06/09/2015] [Indexed: 11/25/2022] Open
Abstract
Background The association of long term combined hormone based contraceptives (CHC) use on bone mineral content (BMC) and areal bone mineral density (aBMD) development remains controversial, as it appears that the relationship may be age-dependent. The purpose of this study was to investigate the long-term associations of CHC exposure on the accrual of bone parameters from adolescence into young-adulthood. Methods 110 women (67 exposed to CHC) were drawn from the Pediatric Bone Mineral Accrual Study (PBMAS). Serial measures of total body (TB), lumbar spine (LS) and femoral neck (FN) BMC and aBMD were assessed by DXA (a total of 950 scans) and aligned by biological age (BA, years from peak height velocity [PHV]). Multilevel random effects models were constructed to assess the time dependent associations between annual CHC exposure and the development of bone parameters. Results After BA, height, lean tissue mass, fat mass, calcium and vitamin D intake, and physical activity were controlled, it was observed that those individuals exposed to CHC 6-years post PHV developed significantly less (−0.00986 ± 0.00422 g/cm2) TB aBMD than their non CHC exposed peers. Additionally, there were significant BA by CHC exposure interactions, where CHC exposure 6-years or more post PHV resulted in developing less TB BMC (−4.94 ± 2.41 g), LS BMC (−0.29 ± 0.11 g) and LS aBMD (−0.00307 ± 0.00109 g/cm2). One year after the attainment of PHV, CHC users were predicted to have 1.2% more TB BMC, 3.8% more LS BMC and 1.7% more LS aBMD than non-users. At 9-years post PHV the predicted differences showed that CHC users had 0.9% less TB BMC and 2.7% less LS BMC and 1.6% less LS BMD than those not exposed to CHC. Conclusions CHC may not hinder the development of BMC or aBMD during adolescence; however, exposure 6-years or more after PHV may be detrimental. The effects of combined hormone contraceptive (CHC) exposure on bone mass were assessed. CHC exposure resulted in developing significantly less (− 9.86 ± 4.22 g/cm2) TB aBMD. CHC exposure 6-years after PHV resulted in significantly less BMC and aBMD. CHC may not hinder adolescent bone development, but may be detrimental after growth.
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Affiliation(s)
- Stefan A Jackowski
- College of Kinesiology, University of Saskatchewan, Saskatoon, SK, Canada
| | | | - Ashlee J McLardy
- College of Kinesiology, University of Saskatchewan, Saskatoon, SK, Canada
| | - Roger A Pierson
- Department of Obstetrics, Gynecology and Reproductive Sciences, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Carol D Rodgers
- College of Kinesiology, University of Saskatchewan, Saskatoon, SK, Canada
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20
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Lee DY, Oh YK, Yoon BK, Choi D. Effects of long-term postoperative oral contraceptive use for the prevention of endometrioma recurrence on bone mineral density in young women. Gynecol Endocrinol 2014; 30:751-4. [PMID: 24927075 DOI: 10.3109/09513590.2014.929653] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Concerns for negative effects of oral contraceptives (OCs) on bone mineral density (BMD) in long-term users have been raised, since OCs suppress the hypothalamic-pituitary-ovarian axis. However, there have been still limited data regarding the effects of long-term OC use on BMD in young women in the twenties. We investigated the effects of long-term OC use for the prevention of endometrioma recurrence on BMD in young women. Ninety-two women aged 20-30 years who underwent conservative surgery for endometrioma and used postoperative OC for at least 12 months to prevent the recurrence were included for this cross-sectional study, and BMDs after OC use were analyzed. The mean age at starting OC and duration of OC use was 25.6 ± 2.9 years and 40.7 ± 28.5 months, respectively. No correlation was found between BMDs and age at starting OC at all sites. In addition, BMDs were also not correlated with the duration of OC use, and were comparable according to the dose of OC (20 versus 30 μg). In conclusion, long-term use of OCs has no adverse effect on BMD in post-adolescent young women.
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Affiliation(s)
- Dong-Yun Lee
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul , Korea
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21
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Admani S, Barrio VR. Evaluation and treatment of acne from infancy to preadolescence. Dermatol Ther 2013; 26:462-6. [DOI: 10.1111/dth.12108] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- Shehla Admani
- Rady Children's Hospital; San Diego California
- University of California, San Diego; La Jolla California
| | - Victoria R. Barrio
- Rady Children's Hospital; San Diego California
- University of California, San Diego; La Jolla California
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