Densitometry findings in women using gestagen contraception

Czech version

Authors: M. Bužga ^1,2 ; V. Šmajstrla ³; L. Bortlík ³; E. Eberová ³; M. Rozbroj ⁴; Č. Dvořáček ⁵; M. Ledvinková ⁴; J. Měch ⁶; R. Pomahač ⁷; H. Fousková ⁷; O. Kempný ⁸
Authors‘ workplace: Ústav fyziologie a patofyziologie FZS OU, Ostrava, přednosta prof. MUDr. Z. Jirák, CSc. ¹; Ústav epidemiologie a ochrany veřejného zdraví FZS OU, Ostrava, přednosta prof. MUDr. V. Janout, CSc. ²; Osteologické pracoviště NZZ Bormed, Ostrava, vedoucí MUDr. V. Šmajstrla ³; Soukromá gynekologická ambulance, Havířov – Šumbark ⁴; Soukromá gynekologická ambulance, Ostrava - Vítkovice ⁵; Soukromá gynekologická ambulance, Ostrava - Zábřeh ⁶; Soukromá gynekologická ambulance GynOrd, Ostrava – Mariánské hory ⁷; Soukromá gynekologická ambulance, Slezská Ostrava ⁸
Published in: Ceska Gynekol 2009; 74(6): 411-416

Overview

Objective:
To prove the influence of gestagen contraception on bone mass with x-ray osteodensitometry (DEXA) with regard to BMI.

Design:
Cross-sectional observational descriptive study.

Setting:
Osteology centre, NZZ Bormed Ostrava.

Methods:
In the study premenopausal women who had been using gestagen contraception (Depo-Provera inj.) at least for one year were included. Bone density was measured in regular manner (whole-body densitometer Hologic W). Z-score at lumbar spine, whole femur and femoral neck was assessed.

Results and conclusions:
58 of 116 patients had normal bone density. In 58 ill patients the bone density dropped below the age norm. In 11 women the Z-score decreased below -2.5 SD. Inverse relationship between BMI and bone density (BMD) was found, both between BMI and Z-score (p=0.0001), and BMI and T-score (p=0.0001). The relationship between duration of gestagen use and bone density was not statistically significant. Marked decline in BMD and correlation with patients‘ low BMI was identified. When prescribing gestagen contraception possible negative effect on skeleton, particularly in women with low BMI should be considered.

Key words:
Depo-Provera, loss of bone mass, densitometry, BMI.

Sources

1. Bachran, LK., Cundy, T., Ott, SM. Depot medroxyprogesterone acetate in teens: A risk for bone health? Pediatrics, 2000, 106, 5, p. 1137-1138.

2. Balasch, J. Sex steroids and bone: current perspectives.. Hum Reprod Update, 2003, 9, 3, p. 207-222.

3. Banks, E., Berrington, A., Casabonne, D. Overview of the relationship between use of progestogen-only contraceptives and bone mineral density. BJOG, 2001, 108, 12, p. 1214-1221.

4. Berenson, AB., et al. Effects of hormonal contraception on bone mineral density after 24 months of use. Obstet Gynecol, 2004, 103, 5, p. 899-906.

5. Bonny, AE., et al. Weight gain in obese and nonobese adolescent girls initiating depot medroxyprogesterone oral contraceptive pills or no hormonal contraception method. Arch Ped Adolesc Med, 2006, 160, 1, p. 40-45.

6. Clark, MK., et al. Bone mineral density changes over two years in first-time users of depot medroxyprogesterone acetate. Fertil Steril, 2004, 82, 6, p. 1580-1586.

7. Clark, MK., et al. Bone mineral density loss and recovery during 48 months in first-time users of depot medroxyprogesterone acetate. Fertil Steril, 2006, 86, 5, p. 1466-1474.

8. Compston, J., et al. Guidelines for the diagnosis and management of osteoporosis in postmenopausal women and men from the age of 50 years in the UK. Maturitas, 2008, 62, 2, p. 105-108.

9. 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, p. 2060-2067.

10. Cromer, BA., et al. Depot medroxyprogesterone acetate and bone mineral density in adolescents – the Black Box Warning: a Position Paper of the Society for Adolescent Medicine. J Adolesc Health, 2006, 39, 2, p. 296-301.

11. Cummings, SR., Bates, DB., Black, DM. Clinical use of Bone densitometry : Scientific review. JAMA 2002, 288, 15, p. 1889-1897.

12. Cundy, T., et al. Spinal bone density in women using depot medroxyprogesterone contraception. Obstet Gynecol, 1998, 92, 4, p. 569-573.

13. de Laet, C., et al. Body mass index as a predictor of fracture risk: A meta-analysis. Osteoporos Int, 2005, 16, 11, p. 1330-1338.

14. del Fattore, A., Teti, A., Rucci, N. Osteoclast receptors and signaling. Arch Biochem Biophys, 2008, 473, 2, p. 147-157.

15. Doporučení k předpisu gestagenní kontracepce: Aktualizace 2006. Čes Gynek, 2006, 71, 5, s. 421-423.

16. Fait, T. Osteoporóza a hormonální kontracepce. Čes Gynek, 2001, 66, 5, s. 309-313.

17. Feng, X. Regulatory roles and molecular signaling of TNF family members in osteoclasts. GENE, 2005, 350, 1, p. 1-13.

18. Honda, A., et al. Lumbar bone mineral density changes during pregnancy and lactation. Intern J Gyneacol Obstet, 1998, 63, 3, p. 253-258.

19. Kanis, JA. Assessment of fracture risk and its application to screening for postmenopausal osteoporosis: : Synopsis of a WHO report. Osteoporosis Int, 2005, 4, 6, p. 368-381.

20. Kanis, JA. Diagnosis of osteoporosis and assessment of fracture risk. Lancet, 2002, 359, 1, p. 1929-1936.

21. Kanis, JA., et al. European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Osteoporos Int, 2008, 19, 1, p. 399-428.

22. Kaunitz, AM., et al. Bone mineral density in women aged 25-35 years receiving depot medroxyprogesterone acetate: recovery following discontinuation. Contraception, 2006, 74, 2, p. 90-99.

23. Kuohung, W., Borgatta, L., Stubblefield, P. Low-dose oral contraceptives and bone mineral density: an evidence-based analysis. Contraception, 2000, 61, 2, p. 77-82.

24. Martins, SL., Curtis, KM., Glasier, AF. Combined hormonal contraception and bone health: a systematic review. Contraception, 2006, 73, 5, p. 445-469.

25. Matsuo, K., Irie, N. Osteoclast-osteoblast communication. Arch Biochem Biophys, 2008, 473, 2, p. 201-209.

26. NIH Consensus Development Panel on Osteoporosis Prevention, Diagnosis, and Therapy. JAMA, 2001, 285, 6, p. 785-795.

27. Obesity: preventing and managing the global epidemic. Report of a WHO consultation. World Health Organ Tech Rep Ser, 2000, 894, i-xii, p. 1-253.

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, p. 469-473.

29. Pikkarainen, E., et al. Estrogen–progestin contraceptive use during adolescence prevents bone mass acquisition: a 4-year follow-up study. Contraception, 2008, 78, 3, p. 226-231.

30. Promislow, JHE., et al. Bed rest and other determinants of bone loss during pregnancy. Am J Obstet Gynecol, 2004, 191, 4, p. 1077-1083.

31. Rager, KM. No bones about it – depot medroxyprogesterone acetate remains an excellent contraceptive option for adolescents. J Pediatr Adolesc Gynecol, 2005, 18, 3, p. 187-188.

32. Ryan, PJ., Singh, SP., Guillebaud, J. Depot medroxyprogesterone and bone mineral density. J Fam Plann Reprod Health Care, 2002, 28, 1, p. 12-15.

33. Shaarawy, M., et al. Effects of the long-term use of depot medroxyprogesterone acetate as hormonal contraceptive on bone mineral density and biochemical markers of bone remodeling. Contraception, 2006, 74, 4, p. 297-302.

34. 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, p. 1538-1544.

35. StataCorp. Stata 10 Base Reference Manual. Texas College Station 2007. 987 p.

36. Syed, Z., Khan, A. Bone densitometry: applications and limitation. J Obstet Gynaecol Can, 2002, 24, 6, p. 476-484.

37. Štěpán, J. Osteoporóza: Koho, kdy a jak léčit?. Čas Lék čes, 2009, 148, 1, p. 25-33.

38. 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.

39. Whiting, P., et al. Evidence-based diagnosis. J Health Serv Res Policy, 2008, Suppl. 3, p. 57-63.

40. Wooltorton, E. Medroxyprogesterone acetate (Depo-Provera) and bone mineral density loss. JAMA, 2005, 172, 6, p. 746-746.