Clin Osteol 2012; 17(4): 123-127

Development of bone mineral density in patients using progestogen-only contraceptivesOriginal contributions

L. Bortlík, M. Bužga, V. Šmajstrla, S. Čuboková

Aim of study: Measurement of bone mineral density (BMD) by DXA in women using progestogen-only contraceptives (depot medro­ xyprogesterone acetate - DMPA, Depo-Provera injections, Pfizer Inc.).

Material and methods: In DMPA users, BMD was reassessed after at least three years of use. All the women were premenopau­ sal. BMD was measured by the Hologic W DXA densitometer in the lumbar spine, total femur and femur neck. BMD and Z-score were evaluated.

Results: Out of 116 DMPA users, 44 could be invited for the reassessment. The mean length of use of DMPA was 8.1 years (range, 3.5 to 12.1 years). No significant changes in BMD in any of the measured skeletal sites were found. Only patients younger than 45 years had a mild but significant increase of BMD in the lumbar spine. The results are surprising and inconsistent with the literature.

Conclusion: The study did not confirm literature data on the adverse impact of the use of DMPA on the skeleton.

Keywords: depot medroxyprogesterone acetate, progestogen-only contraceptive, bone mineral density, densito­ metry

Published: December 11, 2012  Show citation

ACS AIP APA ASA Harvard Chicago Chicago Notes IEEE ISO690 MLA NLM Turabian Vancouver
Bortlík L, Bužga M, Šmajstrla V, Čuboková S. Development of bone mineral density in patients using progestogen-only contraceptives. Osteologický bulletin. 2012;17(4):123-127.
Share...
Download citation
  • BibTeX (.bib)
  • Bookends (.ris)
  • EasyBib (.ris)
  • EndNote (.enw)
  • EndNote 8 (.xml)
  • ISI WoS (.isi)
  • Medlars (.medlars)
  • Mendeley (.ris)
  • MODS (.xml)
  • Papers (.ris)
  • RefWorks (.txt)
  • RefManager (.ris)
  • RIS (.ris)
  • MS Word (.xml)
  • Zotero (.ris)
    • Open full article

    References

    1. Compston J, Cooper A, Cooper C et al. Guidelines for the diagnosis and manage­ ment of osteoporosis in postmenopausal women and men from the age of 50 years in the UK. Maturitas 2008;62(2):105-108. Go to original source...
    2. Kanis JA Assessment of fracture risk and its application to screening for postme­ nopausal osteoporosis: Synopsis of a WHO report. Osteoporosis International 2005;4(6):368-381.
    3. Kanis JA Diagnosis of osteoporosis and assessment of fracture risk. Lancet 2002; 359(1):1929-1936.
    4. Kanis JA, Burlet N, Coper C et al. European guidance for the diagnosis and ma­ nagement of osteoporosis in postmenopausal women. Osteoporos Int 2008; 19(1):399-428. Go to original source...
    5. NIH Consensus Development Panel on Osteoporosis Prevention, Diagnosis, and Therapy. JAMA 2001;285(6):785-795. Go to original source...
    6. Promislow JHE et al. Bed rest and other determinants of bone loss during preg­ nancy. American Journal of Obstetrics and Gynecology 2004;191(4):1077-1083. Go to original source...
    7. Štěpán J. Osteoporóza: Koho, kdy a jak léčit? Časopis lékařů českých 2009; 148(1):25-33.
    8. Honda A et al. Lumbar bone mineral density changes during pregnancy and lac­ tation. Internationla Journal of Gynecology and Obstetrics 1998;63(3):253-258. Go to original source...
    9. Balasch J. Sex steroids and bone: current perspectives. Hum Reprod Update 2003; 9(3):207-222. Go to original source...
    10. Del Fattore A, Teti A, Rucci N. Osteoclast receptors and signaling. Arch Biochem Biophys 2008;473(2):147-157. Go to original source...
    11. Feng X. Regulatory roles and molecular signaling of TNF family members in os­ teoclasts. GENE 2005;350(1):1-13. Go to original source...
    12. Matsuo K, Irie N. Osteoclast-osteoblast communication. Arch Biochem Biophys 2008;473(2):201-209. Go to original source...
    13. Berenson AB et al. Effects ofhormonal contraception on bone mineral density af­ ter 24 months of use. Obstet Gynecol 2004;103(5):899-906. Go to original source...
    14. Cromer BA et al. Bone mineral density in adolescent females using injectable or oral contraceptives: a 24-month prospective study. Fertil Steril 2008;90(6):2060-2067. Go to original source...
    15. Kuohung W, Borgatta L, Stubblefield P. Low-dose oral contraceptives and bone mineral density: an evidence-based analysis. Contraception 2000;61(2):77-82. Go to original source...
    16. Lattáková M, Borovský M, Payer J, Killinger Z. Vplyv hormonálnej antikoncepcie na kostnú denzitu a markery kostného metabolismu u adolescentiek. Osteologický bulletin 2008;13(3):97-101.
    17. Martins SL, Curtis KM, Glasier AF. Combined hormonal contraception and bone health: a systematic review. Contraception 2006;73(5):445-469. Go to original source...
    18. Pikkarainen E et al. Estrogen-progestin contraceptive use during adolescence pre­ vents bone mass acquisition: a 4-year follow-up study. Contraception 2008; 78(3):226-231. Go to original source...
    19. Shoepe HA, Snow CM. Oral contraceptive use in young women is associated with lower bone mineral density than that of controls. Osteoporosis Int 2005;16(12): 1538-1544. Go to original source...
    20. Banks E, Berrington A, Casabonne D. Overview of the relationship between use of progestogen-only contraceptives and bone mineral density. Bjog 2001;108(12): 1214-1221. Go to original source...
    21. Bachran LK, Cundy T, Ott SM. Depot medroxyprogesterone acetate in teens: A risk for bone health? Pediatrics 2000;106(5):1137-1138. Go to original source...
    22. Bužga M, Šmajstrla V, Bortlík L et al. Denzitometrické nálezy u žen užívajících gestagenní hormonální antikoncepci. Čes Gynek 2009;74(6):411^-16.
    23. Clark MK et al. Bone mineral density changes over two years in first-time users of depot medroxyprogesterone acetate. Fertil Steril 2004;82(6):1580-1586. Go to original source...
    24. Cromer BA et al. Depot medroxyprogesterone acetate and bone mineral density in adolescents-the Black Box Warning: a Position Paper of the Society for Adoles­ cent Medicine. J Adolesc Health 2006;39(2):296-301. Go to original source...
    25. Cundy T et al. Spinal bone density in women using depot medroxyprogesterone contraception. Obstet Gynecol 1998;92(4):569-573. Go to original source...
    26. Fait T. Osteoporóza a hormonální kontracepce. Čes Gynek 2001;66(5):309-313.
    27. Kaunitz AM et al. Bone mineral density in women aged 25-35 years receiving de­ pot medroxyprogesterone acetate: recovery following discontinuation. Contracep­ tion 2006;74(2):90-99. Go to original source...
    28. Perrotti M et al. Forearm bone density in long-term users of oral combined contraceptives and depot medroxyprogesterone acetate. Fertil Steril 2001;76(3): 469-473. Go to original source...
    29. Rager KM. No bones about it-depot medroxyprogesterone acetate remains an ex­ cellent contraceptive option for adolescents. J Pediatr Adolesc Gynecol 2005; 18(3):187-188. Go to original source...
    30. Ryan PJ, Singh SP, Guillebaud J. Depot medroxyprogesterone and bone mineral density. J Fam Plann Reprod Health Care 2002;28(1):12-15. Go to original source...
    31. Shaarawy M et al. Effects ofthe long-term use of depot medroxyprogesterone ace­ tate as hormonal contraceptive on bone mineral density and biochemical markers of bone remodeling. Contraception 2006;74(4)297-302. Go to original source...
    32. U.S. Food and Drug Administration. Black box warning added concerning long­ term use of Depo-Provera Contraceptive injection. Available from: http://www.fda.gov/bbs/topics/ANSWERS/2004/ANS01325.html.
    33. Clark MK et al. Bone mineral density loss and recovery during 48 months in first­ time users of depot medroxyprogesterone acetate. Fertility and Sterility 2006; 86(5):1466-1474. Go to original source...
    34. Doporučení k předpisu gestagenní kontracepce: Aktualizace 2006. Čes Gynek 2006;71(5):421-423.

    Return to the content


    Clinical Osteology

    Madam, Sir,
    please be aware that the website on which you intend to enter, not the general public because it contains technical information about medicines, including advertisements relating to medicinal products. This information and communication professionals are solely under §2 of the Act n.40/1995 Coll. Is active persons authorized to prescribe or supply (hereinafter expert).
    Take note that if you are not an expert, you run the risk of danger to their health or the health of other persons, if you the obtained information improperly understood or interpreted, and especially advertising which may be part of this site, or whether you used it for self-diagnosis or medical treatment, whether in relation to each other in person or in relation to others.

    I declare:

    1. that I have met the above instruction
    2. I'm an expert within the meaning of the Act n.40/1995 Coll. the regulation of advertising, as amended, and I am aware of the risks that would be a person other than the expert input to these sites exhibited

    No
    Yes

    If your statement is not true, please be aware
    that brings the risk of danger to their health or the health of others.