Effects of the long-term use of depot medroxyprogesterone acetate as hormonal contraceptive on bone mineral density and biochemical markers of bone remodeling.
OBJECTIVE
Our objective is to evaluate the effects of the long-term use of depot medroxyprogesterone acetate (DMPA) as a method of contraception on bone mineral density (BMD) and bone remodeling. Forty women (21-44 years old) who used DMPA for contraception for <1, 1-2 and >5 years, in addition to 20 age-matched healthy women (nonusers), participated in this study. Lumbar spine BMD (LS-BMD) was measured by dual-energy X-ray absorptionmetry. Serum osteocalcin (OC), a bone formation marker, was measured by enzyme amplification sorbent immunoassay. Urinary deoxypyridinoline (DPD), a bone resorption marker, was determined by enzyme immunoassay.


RESULTS
Serum OC and urinary DPD levels in women who used DMPA for <1, 1-2 and >5 years were significantly increased compared to the corresponding levels in nonusers. The increase of both biomarkers was more pronounced with longer duration of use. LS-BMD was significantly decreased in women on long-term DMPA use compared to LS-BMD in nonusers. The mean percentage decrease of LS-BMD in women who used DMPA for 1-2 and >5 years was 9% and 11.8%, respectively. LS-BMD was negatively correlated with serum OC and urinary DPD in women who used DMPA. On the other hand, LS-BMD and bone turnover were not significantly different between women who used DMPA for <1 year and nonusers.


CONCLUSIONS
Long-term use of DMPA (>2 years) had a significant adverse effect on BMD and induced increased bone turnover, as evidenced by a significant increase in biochemical indices of bone formation and resorption. The measurement of LS-BMD and of biomarkers of bone turnover may be recommended in women aged above 40 years and who used DMPA for a long duration (2-5 years).
Shaarawy
Mohamed
M
Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Cairo 11341, Egypt. mohamedshaarawy@yahoo.com <mohamedshaarawy@yahoo.com>
El-Mallah
Samira Yousef
SY
Seoudi
Samia
S
Hassan
Mohamed
M
Mohsen
Iman Abdel
IA
D000328:Adult; D015415:Biomarkers / Q000097:blood; D015519:Bone Density / Q000187:drug effects*; D016723:Bone Remodeling / Q000187:drug effects*; D015331:Cohort Studies; D003271:Contraceptive Agents, Female / Q000008:administration & dosage; D004343:Drug Implants / Q000627:therapeutic use; D005260:Female; D006801:Humans; D017258:Medroxyprogesterone Acetate / Q000008:administration & dosage* / Q000009:adverse effects; D010024:Osteoporosis / Q000139:chemically induced; D012189:Retrospective Studies; D013995:Time
D015415:Biomarkers; D003271:Contraceptive Agents, Female; D004343:Drug Implants; D017258:Medroxyprogesterone Acetate