Combined hormonal contraceptive use is not protective against musculoskeletal conditions or injuries: a systematic review with data from 5 million females.

Autor:	White L; Tall Tree Physiotherapy and Health Centre, Vancouver, British Columbia, Canada., Losciale JM; Arthritis Research Canada, Vancouver, British Columbia, Canada.; Department of Physical Therapy, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada., Squier K; Department of Physical Therapy, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada.; Centre for Hip Health and Mobility, The University of British Columbia, Vancouver, British Columbia, Canada., Guy S; City Sport + Physiotherapy Clinic, Vancouver, British Columbia, Canada., Scott A; Department of Physical Therapy, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada.; Centre for Hip Health and Mobility, The University of British Columbia, Vancouver, British Columbia, Canada., Prior JC; Centre for Menstrual Cycle and Ovulation Research, The University of British Columbia, Vancouver, British Columbia, Canada.; Women's Health Research Institute, The University of British Columbia, Vancouver, British Columbia, Canada., Whittaker JL; Arthritis Research Canada, Vancouver, British Columbia, Canada jackie.whittaker@ubc.ca.; Department of Physical Therapy, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada.
Jazyk:	angličtina
Zdroj:	British journal of sports medicine [Br J Sports Med] 2023 Sep; Vol. 57 (18), pp. 1195-1202. Date of Electronic Publication: 2023 May 24.
DOI:	10.1136/bjsports-2022-106519
Abstrakt:	Objective: Assess the association between combined hormonal contraceptives (CHC) use and musculoskeletal tissue pathophysiology, injuries or conditions. Design: Systematic review with semiquantitative analyses and certainty of evidence assessment, guided by the Grading of Recommendations Assessment, Development and Evaluation approach. Data Sources: MEDLINE, EMBASE, CENTRAL, SPORTDiscus, CINAHL searched from inception to April 2022. Eligibility: Intervention and cohort studies that assessed the association between new or ongoing use of CHC and an outcome of musculoskeletal tissue pathophysiology, injury or condition in postpubertal premenopausal females. Results: Across 50 included studies, we assessed the effect of CHC use on 30 unique musculoskeletal outcomes (75% bone related). Serious risk of bias was judged present in 82% of studies, with 52% adequately adjusting for confounding. Meta-analyses were not possible due to poor outcome reporting, and heterogeneity in estimate statistics and comparison conditions. Based on semiquantitative synthesis, there is low certainty evidence that CHC use was associated with elevated future fracture risk (risk ratio 1.02-1.20) and total knee arthroplasty (risk ratio 1.00-1.36). There is very low certainty evidence of unclear relationships between CHC use and a wide range of bone turnover and bone health outcomes. Evidence about the effect of CHC use on musculoskeletal tissues beyond bone, and the influence of CHC use in adolescence versus adulthood, is limited. Conclusion: Given a paucity of high certainty evidence that CHC use is protective against musculoskeletal pathophysiology, injury or conditions, it is premature and inappropriate to advocate, or prescribe CHC for these purposes. Prospero Registration Number: This review was registered on PROSPERO CRD42021224582 on 8 January 2021. Competing Interests: Competing interests: JLW is an associate editor of the British Journal of Sports Medicine. (© Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
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