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Systemic Hormonal Contraceptive Use is Associated With Higher Rates of Ligamentous Injuries in the Hand and Wrist
Ankit Hirpara, MD
1, Emma Smolev, MD
1, Pranav Sivaram, BA
1, Nakul Narendran, MD
1, Kira L Smith, MD
1, Matthew V Abola, MD
2; Kevin J Malone, MD
1(1)University Hospitals/Case Western Reserve University, Cleveland, OH, (2)Hospital for Special Surgery, New York, NY
Introduction:Systemic hormonal contraceptives have been shown to modulate the risk of ligamentous injury. They may provide a protective effect by reducing levels of serum relaxin, a catabolic peptide hormone. However, many also contain exogenous estrogen, which may lead to ligamentous laxity. Given these complex interactions, the purpose of this study was to compare rates of ligamentous injuries in the hand and wrist based on contraceptive use.
Methods:The TriNetX database, a federated health data network commonly used in the orthopedic literature, was queried to construct cohorts of female patients aged 15-35 years who had at least one outpatient or office visit. Patients were further stratified based on whether they were non-users or users of different types of systemic hormonal contraceptives (SHC). Rates of ligamentous injury were compared between the following: 1) any SHC (including patches, rings, and injections) versus control, 2) estrogen and progestin combination contraceptive (CC) versus control, 3) progestin-only contraceptive (POC) versus control, 4) oral contraceptive pill (OCP) versus control, and 5) progestin-only pill (POP) versus combination pill (CP). To reduce confounding, contraceptive use must have been documented at least three months prior to the date of injury. For all analyses, cohorts underwent propensity score matching in a 1:1 ratio based on age, body mass index, race, activity level, and relevant co-morbidities. Balance was confirmed by standardized mean differences ? 0.1.
Results:1,958,505 contraceptive users met inclusion criteria. For all analyses, matched cohorts were well-balanced across all covariates (Table 1). Patients taking SHC, POC, or OCP all had significantly higher rates of ligamentous injury compared to controls. There was no significant difference between CC and controls. Interestingly, users of CP had a higher rate of injury compared to users of POP (Table 2).
Conclusion:Systemic hormonal contraceptive use may have a detrimental effect on ligamentous injury in the hand and wrist, possibly due to the adverse effects of exogenous estrogen on collagen structure and tensile strength. This data may be useful in patient counseling, risk stratification, and clinical decision-making regarding contraceptive choice and injury risk.
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