This is an interesting meta-analysis suggesting that combined hormonal contraception (CHC) use in adolescents is associated with a lower peak bone mineral density (BMD) at the lumber spine if used between ages 12 and 19.

CHC use is common and is also used in young girls who have ovarian insufficiency of any cause. We know that adolescence is a time for peak accrual of bone density. Goshtasebi et al. performed a 12‐month LS meta‐analysis with eight paired comparisons in 1535 adolescents showed a weighted mean BMD difference of −0.02 in CHC‐exposed adolescents (P=0.04) and the 24‐month

LS meta-analysis with five paired comparisons in 885 adolescents showed a highly significant weighted mean BMD difference of −0.02 in CHC‐exposed adolescents (P=0.0006). Adjustments for age and/or race, BMI and baseline BMD were made in four out of nine studies.

Not all studies described smoking, calcium intakes, alcohol consumption and exercise levels. This was not a randomised placebo-controlled trial, and describes an association; however, the data are highly statistically significant and we may need to pause for thought when considering CHC use in adolescents who have yet to accrue their peak bone mass.

Read the full article in Clinical Endocrinology 90 517–524