Differential effects on bone density of progestogen-only methods for contraception in premenopausal women.
The question of differential effects on bone density by two different types of progestogen-only methods for contraception in premenopausal women was addressed. Data from a prospective randomized clinical trial among 22 premenopausal women, age 32.6 (range 20-45 years), who were randomly assigned to either of two treatments with continuous progestogens for contraception were analyzed; depot-medroxyprogesterone acetate (DMPA) or continuous levonorgestrel treatment with subdermal implants (Norplant), respectively. Forearm bone density (BMDprox) increased with 2.94% (p = 0.006) in women who were prescribed levonorgestrel, which was in contrast to stable values in those prescribed depot-medroxy-progesterone acetate; group difference at 6 months for BMDprox 3.4% (95% CI 1.3, 5.5; p = 0.025) and BMDdist 4.1% (95% CI - 1.3, 9.6; p = 0.077). The changes in bone density were consistent with the changes in biochemical indices for bone metabolism; DMPA users showed signs of increased bone turnover and users of levonorgestrel showed increased bone formation with increased levels of both alkaline phosphatase (p = 0.004) and osteocalcin (p = 0.007). The findings suggest an increase in bone density during treatment with levonorgestrel and stable values during short-term administration of DMPA, in standard clinical doses for contraception.
Department of Obstetrics & Gynecology, University Hospital, Uppsala, Sweden.
T
T
Naessen
S E
SE
Olsson
J
J
Gudmundson
D000328:Adult; D000469:Alkaline Phosphatase / Q000378:metabolism; D015519:Bone Density / Q000187:drug effects* / Q000502:physiology; D001842:Bone and Bones / Q000187:drug effects / Q000378:metabolism / Q000502:physiology; D003271:Contraceptive Agents, Female / Q000008:administration & dosage / Q000494:pharmacology; D003276:Contraceptives, Oral / Q000494:pharmacology*; D003692:Delayed-Action Preparations; D004343:Drug Implants; D005260:Female; D005542:Forearm; D006801:Humans; D016912:Levonorgestrel / Q000008:administration & dosage / Q000494:pharmacology; D008525:Medroxyprogesterone / Q000008:administration & dosage / Q000494:pharmacology; D008875:Middle Aged; D015675:Osteocalcin / Q000378:metabolism; D017697:Premenopause / Q000502:physiology*; D011372:Progestins / Q000008:administration & dosage / Q000494:pharmacology*; D011446:Prospective Studies; D013997:Time Factors
D003271:Contraceptive Agents, Female; D003276:Contraceptives, Oral; D003692:Delayed-Action Preparations; D004343:Drug Implants; D011372:Progestins; D015675:Osteocalcin; D016912:Levonorgestrel; D000469:Alkaline Phosphatase; D008525:Medroxyprogesterone