Depot medroxyprogesterone and bone mineral density.
OBJECTIVE
To investigate depot medroxyprogesterone (DMPA)-associated bone loss in a general practice setting.


METHODS
Forty-eight patients from a single practice who had used DMPA for contraception for more than 2 years. All patients had a serum oestradiol and if the serum level was <52 pmol/l or >52 pmol/l with menopausal symptoms, bone mineral densitometry (BMD) measurements were made at the lumbar spine (LS) and femoral neck (FN) using dual-energy x-ray absorptiometry (DEXA). Thirty-two patients had bone densitometry, of whom 27 had a serum oestradiol <52 pmol/l and five >52 pmol/l associated with menopausal symptoms. Of the remaining 16 patients, nine patients had a serum oestradiol <52 pmol/l but did not have a BMD as they moved away (five women) or switched to another contraceptive (four women).


RESULTS
BMD results showed a significantly reduced bone mass at both sites with mean Z score LS -0.84 (95% CI -1.17 to -0.52) and FN -0.32 (95% CI -0.62 to -0.02). Eighteen women (56% of 32 women) had either osteopenia (15 cases) (T score < -1.0) or osteoporosis (three cases) (T score < -2.5) at the LS. There were trends to an association of a family history of height loss or tobacco smoking (current or past) for LS and FN Z scores that did not quite achieve significance. There was also a trend to lower body weight in those with a possible family history of osteoporosis or who were smokers and an inverse correlation of weight with BMD at the FN (p < 0.05) and a non-significant inverse correlation at the LS.


CONCLUSIONS
The present results demonstrate that a low bone mass should be considered in patients with prolonged DMPA usage especially if they have risk factors for osteoporosis.
Ryan
P J
PJ
Department of Nuclear Medicine, Medway Hospital, Gillingham, Kent, UK.
Singh
S P
SP
Guillebaud
J
J
D015502:Absorptiometry, Photon; D000293:Adolescent; D000328:Adult; D015519:Bone Density / Q000187:drug effects*; D003271:Contraceptive Agents, Female / Q000009:adverse effects* / Q000494:pharmacology; D004958:Estradiol / Q000097:blood*; D005194:Family Practice; D005260:Female; D006801:Humans; D017258:Medroxyprogesterone Acetate / Q000009:adverse effects* / Q000494:pharmacology; D008875:Middle Aged; D010024:Osteoporosis / Q000139:chemically induced* / Q000000981:diagnostic imaging; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors
D003271:Contraceptive Agents, Female; D004958:Estradiol; D017258:Medroxyprogesterone Acetate