A pilot study examining short-term changes in bone mineral density among class 3 obese users of depot-medroxyprogesterone acetate

Abstract

DMPA-SC administration affects L-spine bone health similarly regardless of BMI status.

The safety of subcutaneously administered depot medroxyprogesterone acetate (104 mg/0.65 mL): A systematic review

“…When a number of cardiometabolic risk markers measured at baseline and at 18 weeks were compared across BMI groups, no differences were noted except for the Disposition Index, a measure of β-cell compensation for insulin resistance, which decreased in obese women (− 286) and increased in nonobese women (188.5) (p = .04) [14]. Finally, small decreases in mean bone mineral density (BMD) at the lumbar spine measured by Dual Energy X-ray Absorbtiometry (DEXA) were noted at 18 weeks postenrolment among all DMPA-SC-users (normal: − 0.083, obese: − 0.091. extremely obese: − 0.112, p = .89), though no difference was reported across BMI groups [15]. All participants had normal BMD at baseline.…”

“…Of the 296 articles identified by the search strategy, 14 satisfied the review inclusion criteria. Twelve articles presented results for seven studies investigating DMPA-SC use among women with four conditions or characteristics identified in the WHO MEC, including obesity [5,[9][10][11][12][13][14][15], age [9][10][11] endometriosis [16][17][18] and HIV [19]. Four of these articles report on results from three multinational pivotal Phase 3 contraceptive trials, including results from two noncomparative trials of DMPA-SC users conducted at sites in North and South America, Europe, and Asia, and a randomized, evaluatorblinded trial comparing DMPA-SC and DMPA-IM users conducted in the United States, Canada, and Brazil [5,[9][10][11].…”

“…Four of these articles report on results from three multinational pivotal Phase 3 contraceptive trials, including results from two noncomparative trials of DMPA-SC users conducted at sites in North and South America, Europe, and Asia, and a randomized, evaluatorblinded trial comparing DMPA-SC and DMPA-IM users conducted in the United States, Canada, and Brazil [5,[9][10][11]. Additional studies included four randomizedcontrolled trials [16][17][18][19] and four reports from a prospective cohort study [12][13][14][15]. As the occurrence of adverse events among women with medical conditions or characteristics using DMPA-SC is relevant for this review, two Phase 3 randomized-controlled noninferiority trials evaluating DMPA-SC use compared with leuprolide and one Phase 2 randomized controlled trial evaluating DMPA-SC compared with elagolix in the setting of endometriosis, were considered as noncomparative prospective studies for the purposes of this review [16,17].…”

“…Eight reports from three studies, including two Phase 3 trials and a small prospective cohort, of fair to poor quality suggest that the safety of DMPA-SC use among obese women is similar to nonobese women; and, obese users of DMPA-SC and DMPA-IM experience similar adverse effects [5,[9][10][11][12][13][14][15]. Further, limited evidence from these Phase 3 trials also suggest that the safety of DMPA-SC use among subgroups of premenopausal adult women is also similar and that these women experience infrequent and comparable adverse effects when DMPA-SC and DMPA-IM are used in these populations; no studies reported on adverse outcomes among adolescents [9,11].…”

“…Four poor-quality reports from a small prospective cohort study evaluated a number of potential adverse effects of DMPA-SC use among five normal BMI (18.5-24.9 kg/m 2 ), five obese (30.0-39.9 kg/m 2 ), and five extremely obese (≥ 40 kg/m 2 ) DMPA-SC users during 26 weeks of follow-up, or two injection cycles [12][13][14][15]. One reported serum measures of progesterone (P 4 ), estradiol (E 2 ) and medroxyprogesterone acetate (MPA) collected weekly, bi-weekly and monthly, as a means to quantify follicular development and ovulation among obese and nonobese DMPA-SC users [12].…”