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Depot medroxyprogesterone and bone mineral density
  1. P J Ryan, MD, FRCP, Consultant Physician1,
  2. S P Singh, MBBS, Dip Obs, General Practitioner2 and
  3. J Guillebaud, FRCOG, MFFP, Medical Director3
  1. Department of Nuclear Medicine, Medway Hospital, Windmill Road, Gillingham, Kent, UK
  2. Chatham, Kent, UK
  3. Margaret Pyke Centre, 73 Charlotte Street, London W1P 1LB, UK
  1. Correspondence Dr P J Ryan, Consultant Physician, Department of Nuclear Medicine, Medway Hospital, Windmill Road, Gillingham, Kent ME7 5NY, UK

Abstract

Objective To investigate depot medroxyprogesterone (DMPA)-associated bone loss in a general practice setting.

Design 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.

Conclusion 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.

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