Predictors of higher bone mineral density loss and use of depot medroxyprogesterone acetate.
OBJECTIVE
To identify possible predictive factors of higher bone loss, defined as at least 5%, at the spine or femoral neck, over time in depot medroxyprogesterone acetate (DMPA) users.


METHODS
Bone mineral density (BMD) was measured at the lumbar spine and femoral neck every 6 months in 240 white, African-American, and Hispanic women using DMPA. For the purpose of analysis, an arbitrary value of at least 5% BMD loss from the baseline value after 24 months of DMPA use at either the lumbar spine or the femoral neck was considered as higher BMD loss. Logistic regression analysis was then used to examine factors predictive of at least 5% BMD loss at either site.


RESULTS
Of the initial 240 DMPA users, 95 completed 24 months of follow-up. Forty-five of the 95 DMPA users (47.4%) had at least 5% BMD loss at the lumbar spine or femoral neck by 24 months. Multivariable logistic regression model showed that at least 5% BMD loss was associated with current smoking (adjusted odds ratio [OR] 3.88, 95% confidence interval [CI] 1.26-11.96), calcium intake (in 100 mg) (OR 0.81, 95% CI 0.65-0.99), and parity (OR 0.49, 95% CI 0.29-0.82). Age, race or ethnicity, previous contraceptive use, and body mass index were not associated with higher BMD loss.


CONCLUSIONS
The risk of higher BMD loss associated with DMPA use may be reduced by quitting smoking and increasing calcium intake. Having had a child is also protective.


METHODS
II.
Rahman
Mahbubur
M
From the Department of Obstetrics and Gynecology and the Center for Interdisciplinary Research in Women's Health, The University of Texas Medical Branch, Galveston, Texas.
Berenson
Abbey B
AB
D000328:Adult; D015519:Bone Density / Q000187:drug effects*; D002136:Calcium, Dietary / Q000008:administration & dosage; D003271:Contraceptive Agents, Female / Q000008:administration & dosage*; D003692:Delayed-Action Preparations; D005260:Female; D005272:Femur Neck / Q000502:physiology; D006801:Humans; D016015:Logistic Models; D008159:Lumbar Vertebrae / Q000502:physiology; D017258:Medroxyprogesterone Acetate / Q000008:administration & dosage*; D010298:Parity; D011247:Pregnancy; D012907:Smoking / Q000503:physiopathology
D002136:Calcium, Dietary; D003271:Contraceptive Agents, Female; D003692:Delayed-Action Preparations; D017258:Medroxyprogesterone Acetate