title: Associations between fracture incidence and use of depot medroxyprogesterone acetate and anti-epileptic drugs in women with developmental disabilities.
abstract: OBJECTIVE
  We sought to evaluate any association between incidence of osteoporotic fractures and use of depot medroxyprogesterone acetate (DMPA) and/or anti-epileptic drugs (AEDs) among women and girls with developmental disabilities.
  
  
  METHODS
  Cross-sectional population-based observational study of all noninstitutionalized females with developmental disabilities age >/=13 who received fee-for-service Medicaid in Washington State during 2002 (n = 6,773), using administrative data.
  
  
  RESULTS
  In a sample of 6,773 females, 140 women (2%) had an osteoporotic fracture during 2002. Among 340 users of DMPA, 13 (3.8%) had an osteoporotic fracture with an odds ratio of 2.4 (95% confidence interval [CI], 1.3-4.4) for fracture compared to nonusers. Among 1,909 users of AEDs, 60 (3.1%) had an osteoporotic fracture with an odds ratio of 1.9 (95% CI, 1.3-2.6) for fracture compared to nonusers. We controlled for use of drugs (DMPA or AEDs), age and race (as white or other racial and ethnic groups).
  
  
  CONCLUSIONS
  Use of either AEDs or DMPA by women with developmental disabilities is associated with significantly increased incidence of fracture. Women and girls who have developmental disabilities may be poor candidates for DMPA use owing to increased risk of fractures. Further research is indicated to 1) determine the specific risks profile of DMPA for this population, 2) explore alternative means of managing significant menstrual problems and contraceptive needs in this population, and 3) screen current and previous users of DMPA and chronic users of AEDs for osteoporosis risk, regardless of age.
authors.affiliation: Biobehavioral Nursing and Health Systems, School of Nursing, Seattle, Washington 98195, USA. watsonkc@u.washington.edu
authors.forename: Kathleen C
authors.initials: KC
authors.lastname: Watson
authors.forename: Martha J
authors.initials: MJ
authors.lastname: Lentz
authors.forename: Kevin C
authors.initials: KC
authors.lastname: Cain
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000927:Anticonvulsants / Q000008:administration & dosage; D016001:Confidence Intervals; D003271:Contraceptive Agents, Female / Q000009:adverse effects*; D003692:Delayed-Action Preparations / Q000009:adverse effects; D006233:Persons with Disabilities / Q000706:statistics & numerical data*; D005260:Female; D005598:Fractures, Spontaneous / Q000139:chemically induced / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D008484:Medicaid; D017258:Medroxyprogesterone Acetate / Q000009:adverse effects*; D008875:Middle Aged; D016017:Odds Ratio; D010024:Osteoporosis / Q000453:epidemiology; D012307:Risk Factors; D014861:Washington / Q000453:epidemiology; D016387:Women's Health
chemical_list: D000927:Anticonvulsants; D003271:Contraceptive Agents, Female; D003692:Delayed-Action Preparations; D017258:Medroxyprogesterone Acetate