Oral contraceptive use may protect against low bone mass

Article Abstract:

Osteoporosis, or thinning of the bones, is a disease that primarily affects postmenopausal women. Premenopausal women produce estrogen, which protects the bones by promoting increased bone mineral density (BMD) or thickness. With the dramatic drop in estrogen levels after menopause, women's bones become thinner, predisposing them to fracture. Giving estrogen during and after menopause can prevent this thinning. Some studies have suggested that oral contraceptives or birth control pills, which contain high levels of estrogens, also increase bone thickness. A study of BMD in 2,297 women was done, with particular attention focused on earlier oral contraceptive use, to determine if premenopausal use of birth control pills might retard osteoporosis. Postmenopausal women had significantly lower BMDs than premenopausal women, but those who had a history oral contraceptive use were far more likely to have a high postmenopausal BMD than those who had never taken the pill. A possible explanation for this phenomenon is that bone mass increased significantly in women who took oral contraceptives when younger, and they entered menopause with higher BMDs. One important fact in this study is that the women observed were of such an age that the oral contraceptive preparations they had taken were the older, high-estrogen compounds. More modern versions of the pill use much lower doses of estrogen, so whether the association observed between oral contraceptive use and higher postmenopausal BMD will hold true for current pill users is unclear. However, in the population studied, premenopausal oral contraceptive use was found to have benefits for skeletal strength both during the time the drugs were used and the postmenopausal years. (Consumer Summary produced by Reliance Medical Information, Inc.)

Bones, Prevention, Physiological aspects, Bone density, Oral contraceptives, Menopause, Osteoporosis, Estrogen, Estrogens

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Corticosteroid-associated perforation of colonic diverticula

Article Abstract:

Advancing age and westernized diets increase the likelihood of developing colonic diverticula, which are outpouchings of the lining of the colon. They are generally asymptomatic, and are often only an incidental finding on X-rays taken for some other purpose. However, in a small number of cases, the diverticula may become inflamed (diverticulitis), and in a condition roughly analogous to appendicitis, may perforate (burst), leading to serious or even fatal peritonitis (infection of the abdominal cavity). What is often not widely appreciated among physicians is that this situation may develop as a consequence of treatment with corticosteroids. It is, however, well known that the perforation of a peptic ulcer may be a catastrophic adverse effect of corticosteroid treatment. In three cases, one which ended in death, perforation of colonic diverticula was associated with the use of corticosteroid drugs. It is especially unfortunate that the action of the corticosteroid drugs, in addition to causing the perforation, also masks its symptoms. While perforation normally causes more dramatic symptoms, patients taking corticosteroids may only feel abdominal discomfort. This may result in a serious delay in recognizing the condition, and doubtlessly contributes to the higher mortality which is observed among patients taking corticosteroids. Patients, particularly those over 50, should be questioned about any preexisting diverticular disease prior to the prescription of corticosteroids. Patients should also be warned to be alert for abdominal discomfort, which may be the only symptom of the potentially fatal perforation. (Consumer Summary produced by Reliance Medical Information, Inc.)

Complications and side effects, Diverticulosis, Adrenocortical hormones, Steroid hormones, Diverticulitis, Diverticular disease

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