Change in Bone Mineral Density Among Adolescent Women Using and Discontinuing Depot Medroxyprogesterone Acetate Contraception

Scholes, Delia; LaCroix, Andrea Z.; Ichikawa, Laura; Barlow, William E.; Ott, Susan M.

doi:10.1001/archpedi.159.2.139

Cited by 198 publications

(118 citation statements)

References 33 publications

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“…Discontinuation of DMPA is associated with rapid improvements in bone mass, although it is not known how much of potential maximum peak bone mass is recovered. 96 For most adolescents, the risk of fracture while taking DMPA is low, and the benefit of taking the medication outweighs the risks. The Society for Adolescent Health and Medicine recommends continuing to prescribe DMPA to adolescent girls needing contraception but recommends explanation of the risks and benefits.…”

Section: Secondary Prevention: Assessment Of Populations At Risk For mentioning

confidence: 99%

Optimizing Bone Health in Children and Adolescents

Daniels¹,

Abrams²,

Corkins³

et al. 2014

Pediatrics

393

310

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The pediatrician plays a major role in helping optimize bone health in children and adolescents. This clinical report reviews normal bone acquisition in infants, children, and adolescents and discusses factors affecting bone health in this age group. Previous recommended daily allowances for calcium and vitamin D are updated, and clinical guidance is provided regarding weight-bearing activities and recommendations for calcium and vitamin D intake and supplementation. Routine calcium supplementation is not recommended for healthy children and adolescents, but increased dietary intake to meet daily requirements is encouraged. The American Academy of Pediatrics endorses the higher recommended dietary allowances for vitamin D advised by the Institute of Medicine and supports testing for vitamin D deficiency in children and adolescents with conditions associated with increased bone fragility. Universal screening for vitamin D deficiency is not routinely recommended in healthy children or in children with dark skin or obesity because there is insufficient evidence of the cost–benefit of such a practice in reducing fracture risk. The preferred test to assess bone health is dual-energy x-ray absorptiometry, but caution is advised when interpreting results in children and adolescents who may not yet have achieved peak bone mass. For analyses, z scores should be used instead of T scores, and corrections should be made for size. Office-based strategies for the pediatrician to optimize bone health are provided. This clinical report has been endorsed by American Bone Health.

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Section: Secondary Prevention: Assessment Of Populations At Risk For mentioning

confidence: 99%

Optimizing Bone Health in Children and Adolescents

Daniels¹,

Abrams²,

Corkins³

et al. 2014

Pediatrics

393

310

View full text Add to dashboard Cite

show abstract

“…72 Five studies (1 large cross-sectional 73 and 4 prospective 74 -77 ) in premenopausal women showed that spine BMD improved faster than hip BMD following cessation of DMPA, 74 -77 the rate of improvement was faster in those who had used DMPA for longer 76 and that the effects were reversible 73,75 -77 by 30 months of cessation as compared with non-users. 74 Two studies on postmenopausal women showed that those who had used DMPA up to the menopause lost less bone after the menopause than non-users, such that by the age of 60 + 5 years the BMD measurements between the users and the non-users were equivalent.…”

Section: Osteoporosismentioning

confidence: 99%

Contraception for Women with Medical Problems

Chen¹,

Culwell²

2015

GLOWM

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Summary: Women with medical disease have a higher incidence of maternal mortality compared with healthy women, with cardiac disease now being the most common cause of maternal death in the UK. A handful of medical conditions exist where pregnancy is not recommended due to mortality rates approaching 50%. It is imperative that such women have the most reliable methods of contraception available. Contraceptive agents may themselves affect medical disease, or may interact with medications used by such women. There may be a range of contraceptive agents suitable for each medical condition. The contraceptive selected should be tailored to suit the individual. The following points should be considered when deciding on the most appropriate contraceptive agent: efficacy, thrombotic risk (oestrogen containing contraceptives), arterial risks (oestrogen containing contraceptives), infective risk (e.g. insertion of intrauterine device [IUD]), vagal stimulation (e.g. insertion of IUD, ESSURE w ), bleeding risks with patients on anticoagulants, interaction with concomitant drugs, effects of anaesthesia and ease of use. This review aims to cover the different contraceptive agents available and the best ones to use for certain medical illnesses.

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“…Use of DMPA in the general population has been associated with significant decreases in BMD (Berenson, Radecki, Grady, Rickert & Thomas, 2001;Scholes, LaCroix, Ott, Ichikawa & Barlow, 1999;Scholes, LaCroix, Ichikawa, Barlow & Ott, 2002;Scholes, LaCroix, Ichikawa, Barlow & Ott, 2005) and rates of bone resorption that are higher than rates of bone formation (Ott et al 2001). In the only reported study to prospectively measure baseline BMD on all participants prior to initiation of DMPA (Clark, Sowers, Nichols & Levy, 2004), first-time DMPA users experienced bone loss which began with the first injection and continued through at least two years of continuous use.…”

mentioning

confidence: 99%

“…In the only reported study to prospectively measure baseline BMD on all participants prior to initiation of DMPA (Clark, Sowers, Nichols & Levy, 2004), first-time DMPA users experienced bone loss which began with the first injection and continued through at least two years of continuous use. There appears to be recovery of BMD beginning immediately following discontinuation, but how much recovery can be expected and over what period of time remain to be determined (Scholes, et al 2005). …”

mentioning

confidence: 99%

Associations between fracture incidence and use of depot medroxyprogesterone acetate and anti-epileptic drugs in women with developmental disabilities

Watson

Lentz

Cain

2006

Women's Health Issues

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Purpose-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 non-institutionalized females with developmental disabilities age thirteen and older who received fee-for-service Medicaid in Washington State during 2002 (N=6773), using administrative data.Main Findings-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 (CI 95%, 1.3-4.4) for fracture compared to non-users. Among 1909 users of AEDs, 60 (3.1%) had an osteoporotic fracture with an odds ratio of 1.9 (CI 95%, 1.3-2.6) for fracture compared to non-users. We controlled for age and race (as Caucasian or non-Caucasian).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 due to increased risk of fractures. Further research is indicated (1) to determine the specific risks profile of DMPA for this population, (2) to explore alternative means of managing significant menstrual problems and contraceptive needs in this population and (3) to screen current and previous users of DMPA and chronic users of AEDs for osteoporosis risk, regardless of age.Correspondence to: Kathleen C. Watson, watsonkc@u.washington.edu. Support for this study was provided by NINR NIH 5 T32 NR07106-07 and by NINR NIH P30 NR04001.Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. People who have developmental disabilities (DD) are at increased risk of fractures due to cooccurrence of low BMD (Aspray et al. 1998;Jaffe, Timell, & Gulanski, 2001;Lohiya, TanFigueroa, & Iannucci, 2004) and increased incidence of falls and other trauma (Hsieh, Heller & Miller, 2001). Developmental disabilities are severe and chronic disabilities which begin before age 22 and are the result of mental retardation, cerebral palsy, epilepsy, autism or a similar condition (U.S. code Title 42, chapter 75, section 6001.5.1, 1992). They include a wide range of both physical and cognitive disabilities and many have associated health problems. NIH Public AccessDocumented risks for low BMD include limited mobility (Lohiya et al. 2004;Tyler, Snyder & Zyzanski, 2000;Jaffe, Timell, Elolia & Thatcher, 2005), use of anti-epileptic drugs (AEDs) (Ray, Papaioan...

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Change in Bone Mineral Density Among Adolescent Women Using and Discontinuing Depot Medroxyprogesterone Acetate Contraception

Abstract: Use of DMPA contraception in adolescents was associated with significant continuous losses of bone mineral density at the hip and spine. However, significant gains postdiscontinuation provide evidence that the loss of bone mass is apparently reversed.

Cited by 198 publications

References 33 publications

Optimizing Bone Health in Children and Adolescents

Optimizing Bone Health in Children and Adolescents

Contraception for Women with Medical Problems

Associations between fracture incidence and use of depot medroxyprogesterone acetate and anti-epileptic drugs in women with developmental disabilities

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