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Bone mineral density and depot medroxyprogesterone acetate
Paola Albertazzi1, Mirella Bottazzi, Susan A Steel
1Centre for Metabolic Bone Disease, University of Hull, Hull HU3 2RW, UK. p.albertazzi@doctors.org.uk
Contraception
|May 30, 2006
Summary
Depot medroxyprogesterone acetate (DMPA) use before peak bone mass may harm bone density. Switching to oral combined pills (OCP) after DMPA does not appear to improve bone density in young women.
Area of Science:
- Endocrinology
- Bone Metabolism
- Reproductive Health
Background:
- Depot medroxyprogesterone acetate (DMPA) suppresses ovulation and estrogen production, potentially harming bone health, especially in young women by impeding peak bone mass.
- The impact of sequential contraceptive use, specifically DMPA followed by other methods like oral combined pills (OCP), on bone mineral density (BMD) in young women is not well-understood.
Purpose of the Study:
- To investigate the association between sequential contraceptive use, including DMPA and OCP, and bone mineral density (BMD) in women aged 20 years and older.
- To assess the prevalence of low bone mass and fractures in women using DMPA, and to identify risk factors associated with these conditions.
Main Methods:
- A cross-sectional analysis was conducted on 218 women aged 20 years or older using DMPA, with BMD assessed at the time of the study.
- Data on prior and current contraceptive use, including DMPA and OCP, duration of use, and other demographic factors were collected.
- Logistic regression modeling was employed to determine the association between potential risk factors and low bone mass.
Main Results:
- The prevalence of low bone mass (T-score ≤ -1) was 41%, with 5% having a T-score below -2.5. Notably, 45% of women had experienced at least one fracture.
- Younger age was initially associated with higher BMD, but this protective effect was lost when considering the interaction between DMPA and OCP duration.
- Using DMPA before OCP was particularly detrimental to BMD (OR, 3.94), while higher body mass index was positively associated with BMD (OR, 0.86).
Conclusions:
- Sequential use of DMPA before achieving peak bone mass may negatively impact bone density, and switching to OCP does not appear to offer specific bone protection benefits.
- These findings suggest that DMPA users, particularly those using it before peak bone mass, are at high risk for low BMD and fractures, necessitating careful consideration in contraceptive guidelines.
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