GRADE table 1(Question 1): Are women who use combined hormonal contraceptives (CHCs) at increased risk for fracture compared with women who do not use CHCs? (Direct evidence)

OutcomeType and number of studies
(number of participants)		LimitationsInconsistencyImprecisionIndirectnessOther factorsQualityEstimate of effect
Oral combined hormonal contraceptive use vs non-use
Fracture3 cohort studies (n=128 255);
7 case-control studies (n=84 695 cases)		Serious limitations
(1 good, 6 fair, 3 poor)		Serious inconsistencyNo serious imprecisionSerious indirectness
(no study specifically evaluated CHC use during adolescence)		No duration-response effect observedLow7 studies showed no association between CHC use and fracture risk, including 1 good-quality study (OR 1.05, 95% CI 0.86–1.29); 3 studies found a statistically significant but weak association (risk estimate range 1.07–1.3)a

CI: confidence interval; OR: odds ratio.

a

Six studies evaluated any fracture, two studies hip fracture, two studies forearm fracture.

From: I, Development of the Medical eligibility criteria for contraceptive use, fifth edition

Cover of Medical Eligibility Criteria for Contraceptive Use
Medical Eligibility Criteria for Contraceptive Use. 5th edition.
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