الفهرس 
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Abstract
This study is an analytic cross-sectional retrospective study. It was conducted at the maternity department of AL MAADI MELITARY HOSPITAL to define the relation between oral contraceptive pills, bone mass density and serum alkaline phosphatase. The subjects participating in the study were divided into two groups:
Group A
Thirty women who used combined oral contraceptive pills (0.15 mg levonorgestrel or desogestrel respectively + 0.03 mg ethinylestradiol) 6-12 months.
Group B:
Thirty women who had never used any hormonal contraceptives.
DEXA was done to all women included in the study and serum alkaline phosphatase was measured also.
IN THIS STUDY:
• There was no statistically significant difference between the two groups regarding age.
• There were no statistically significant difference between the two groups regarding parity.
• There were no statistically significant difference between the two groups regarding occupation.
• There was no statistically significant difference between the two groups as regard BMI.
• The mean serum alkaline phosphatase level was higher in group 1compared to group 2 & there was statistically significant difference (P value = 0.011).
• There was statistically significant difference between the two groups regarding spine bone mineral density (P value = 0.019).
• There was statistically significant difference between the two groups as regard BMD of Lt femur (P value=0.008), the mean was higher in group 2 compared to group 1.
• There was statistically significant difference between the two groups as regard BMD of Rt femur (P value=0.017), the mean was higher in group 2 compared to group 1.
• There was statistically significant difference among the two group as regarding spine t-score (P value=0.007).
• As regard t-score of Rt femur there was NO statistically significant difference between the two groups (P-value=0.053).
• As regard t-score of Lt femur there was statistically significant between the two group (P value=0.014).difference.
• There was statistically significant difference between the two groups as regards degree of osteoporosis ( P-value=0.010).
• There was no correlation between type of occupation & the degree of osteoporosis.
• There was no correlation between BMI& the degree of osteoporosis.
• Serum alkaline phosphatase inversely correlated to all DEXA scan parameters.
• BMD of spine strongly positively correlated to t-score of the spine (r = 0.976).
• BMD of Lt femur strongly positively related to BMD of Rt femur (r = 0.858).
• BMD of Lt femur strongly positively related to t-score of Lt femur (r = 0.959).
• BMD of Rt femur strongly positively related to t-score of Lt femur (r = 0.915).
Regarding to bone health, the combined oral contraceptives do not affect bone density much, and any effect that they do have is not likely to increase a woman’s chance of bone fracture. Some research studies have found that adolescents who use this type of contraception have slightly lower bone density while using it, and others have found that women who are entering menopause may have slightly higher bone densities. However, all of these changes are much smaller than what would be needed to increase a woman’s chance of fracturing her bones. The combined hormonal contraceptives such as the vaginal ring, the patch and the injectables that contain two types of hormones have not been well researched for their effect on bone health (World Health Organization, 2007).
Bone mineral density (BMD) measurements are commonly used to assess fracture risk, but the accuracy of measurements can be influenced by changes in body composition, including changes in lean body mass and fat. Furthermore, fracture risk is related to many factors, BMD being only one of them. The relationship between decrease in BMD and increase in fracture risk has been best studied in postmenopausal women, among whom the risk of any fracture increases approximately 1.5-fold for each standard deviation (SD) decrease in BMD (Luis Bahamondes et al., 2005).