Oral-contraceptive use and risk of hip fracture: a case-control study

Background Epidemiological studies indicate a protective effect of postmenopausal oestrogen therapy on the risk of osteoporotic fractures. Whether premenopausal oestrogen exposure in the form of oral contraceptives also reduces the risk of osteoporotic fractures remains uncertain. Methods We did a population-based case control study of hip fracture among Swedish postmenopausal women, 50–81 years of age, through mailed questionnaires and telephone interviews. Of those women who were eligible, 1327 (82·5%) cases and 3312 (81·6%) randomly selected controls responded. Findings 130 (11·6%) cases and 562 (19·1%) controls reported ever-use of oral contraceptives. Ever-use of oral contraceptives was associated with a 25% reduction in hip fracture risk (odds ratio 0·75 [95% Cl 0·59–0·96]). Women who had ever used a high-dose pill (equivalent to greater-or-equal, slanted50 μg ethinylestradiol per tablet) had a 44% lower risk for hip fracture than never-users (0·56 [0·42–0·75]). No overall trend was observed with duration of oral-contraceptive use, or time since last use. However, when making comparisons with women who have never used oral contraceptives, the odds ratios for hip-fracture were 0·69 (0·51–0·94) for use after age 40, 0·82 (0·57–1·16) for use at ages 30–39, and 1·26 (0·76–2·09) for use before age 30. Interpretation Our results imply that in postmenopausal women, oral-contraceptive use late in reproductive life may reduce the risk of hip fracture, although we recognise the limitations of the case-control method.