Abdul-Hameed, D., Alassaf, F., Abed, M. (2026). Bone Turnover and the Folate–Homocysteine Pathway in Women Using Combined Oral Contraceptives. , (), -. doi: 10.33899/iraqij.p.2026.170376.1198
Dalal M. Abdul-Hameed; Fawaz A. Alassaf; Mohammed N. Abed. "Bone Turnover and the Folate–Homocysteine Pathway in Women Using Combined Oral Contraceptives". , , , 2026, -. doi: 10.33899/iraqij.p.2026.170376.1198
Abdul-Hameed, D., Alassaf, F., Abed, M. (2026). 'Bone Turnover and the Folate–Homocysteine Pathway in Women Using Combined Oral Contraceptives', , (), pp. -. doi: 10.33899/iraqij.p.2026.170376.1198
Abdul-Hameed, D., Alassaf, F., Abed, M. Bone Turnover and the Folate–Homocysteine Pathway in Women Using Combined Oral Contraceptives. , 2026; (): -. doi: 10.33899/iraqij.p.2026.170376.1198

Bone Turnover and the Folate–Homocysteine Pathway in Women Using Combined Oral Contraceptives

Iraqi Journal of Pharmacy
Articles in Press, Accepted Manuscript, Available Online from 26 May 2026
Document Type: Research Paper
DOI: 10.33899/iraqij.p.2026.170376.1198
Authors
Dalal M. Abdul-Hameed1; Fawaz A. Alassaf* 1; Mohammed N. Abed2
1Department of Pharmacology and Toxicology, College of Pharmacy, University of Mosul, Mosul, Iraq
2Department of Clinical Laboratory Sciences, College of Pharmacy, University of Mosul, Mosul, Iraq
Abstract
Background: The metabolic pathways of the folate-homocysteine pathway including folic acid, vitamin B12, and homocysteine are linked to bone quality and skeletal integrity. The impact of combined oral contraceptives (COC) on this metabolic pathway and its interaction with bone turnover markers remains an area of research. Objectives: This study aims to investigate the association of bone turnover markers with folate-homocysteine metabolic pathways in women using COC. Methods: A total of 84 women (42 controls and 42 COCs users) were recruited, blood withdrawn and serum separated. Serum folic acid, vitamin B12, homocysteine, and parathyroid hormone were all measured using ELISA technique and bone turnover markers (osteocalcin and bone specific alkaline phosphatase, and C-terminal telopeptide type I collagen) were also measured. Results: The use of COC in women was associated with a significant increase in osteocalcin levels (4.83 ± 1.15 ng/ml) compared to controls (3.38 ± 1.13 ng/ml, p = 0.001), while folic acid levels were also significantly higher in COC users (16.40 ± 4.28 ng/ml) than in controls (12.92 ± 4.09 ng/ml, p = 0.02). Positive correlations of both folic acid and vitamin B12 with bone turnover markers (osteocalcin, bone-specific alkaline phosphatase, and C-terminal telopeptide type I collagen) were demonstrated. Homocysteine showed a positive correlation with bone-specific alkaline phosphatase. Conclusion: Combined oral contraceptives use is associated with the alterations of bone remodeling process and the folate-homocysteine metabolic pathway. The outcomes of the study suggest that folic acid and vitamin B12 may play a role in modulating bone metabolism, highlighting the importance of considering hormonal and nutritional status in the assessment of bone health in women using combined oral contraceptives.
Keywords
Combined oral contraceptives; Bone turnover markers; Bone health; Folic acid; Homocysteine
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