Changes in calcium metabolism and bone mineral density in new users of medroxyprogesterone acetate during the first year of use

Abstract

Objective To evaluate calcium metabolism and bone mineral density (BMD) in new users of depot medroxyprogesterone acetate (DMPA) in the first year of use. Methods This prospective, non‐randomized study, conducted at the University of Campinas, São Paulo, Brazil, was carried out between February 2011 and February 2013. Women aged from 18 to 40 with a body mass index (BMI, calculated as weight in kilograms divided by the square of height in meters) <30 and with no known history of disease or medication use who chose to use DMPA were paired by age (±1 year) and BMI (±1) with women commencing the use of a copper intrauterine device (IUD). The primary outcomes were BMD measured by dual‐energy X‐ray absorptiometry and calcium metabolism markers; other variables were body composition and lifestyle habits. Repeated measures analysis of variance (ANOVA) and multiple regression analyses were used to evaluate associations. Results Twenty‐seven women using DMPA and 24 using IUD were evaluated, with a mean age of 29.7 years and 28.6 years, respectively. The DMPA group presented with a 3.6% (P<0.001) loss of lumbar spine BMD, a 2.1% (P=0.100) loss of femoral neck BMD and higher phosphorus (P=0.014) concentrations at 12 months compared to the IUD group. The decreases in BMD were associated with the use of DMPA, while total mass and coffee intake were found to be protective factors. Conclusion Changes in calcium metabolism and a decrease in BMD were found in the DMPA group at 12 months.

Bone Mineral Density in Antiretroviral Therapy‐Naïve HIV‐1–Infected Young Adult ‐Women Using Depot Medroxyprogesterone Acetate or Nonhormonal Contraceptives in Uganda

“…Our finding of a strong negative effect of current DMPA use on BMD is consistent with previous studies conducted among the general population, in whom BMD losses of up to 7.5% of BMD after 2 or more years of use were recorded with the greatest loss being during the first 1 to 2 years. ( 50,51 ) Because of the hypoestrogenic effects of DMPA, current DMPA users have been shown to have lower mean BMD than nonusers, and these effects are more pronounced in younger women. ( 51,52 ) Post hoc exploratory analysis showed that untreated HIV‐1–infected current DMPA users had lower BMD compared with untreated nonhormonal users regardless of disease status or CD4 cell count (data not shown).…”

“…( 50,51 ) Because of the hypoestrogenic effects of DMPA, current DMPA users have been shown to have lower mean BMD than nonusers, and these effects are more pronounced in younger women. ( 51,52 ) Post hoc exploratory analysis showed that untreated HIV‐1–infected current DMPA users had lower BMD compared with untreated nonhormonal users regardless of disease status or CD4 cell count (data not shown). These results imply that DMPA has a stronger negative effect on BMD than HIV‐1 itself, and the severity of HIV as measured by a decline in CD4 cell count may play a smaller role in the process of BMD loss.…”

Glucocorticoid-induced osteoporosis in premenopausal women: management for the rheumatologist

“…Contraception choices and the use of estrogen is also a pertinent issue when thinking about bone health in premenopausal women. Depoprovera is associated with bone loss [4 ▪▪ ,51,52]. This, combined with glucocorticoid use or other risk factors for bone loss in the population with autoimmune disease, particularly when utilized in early decades of life when peak bone mass has not yet formed is of concern for long-term effects.…”