Last Bone Mineral Density and DMPA Use in Low

8/7/2019 Last Bone Mineral Density and DMPA Use in Low

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Dalia G.Mahran, Mostafa Hussein, Osama Farouk, Maher ElAssal, M. Fathallah and M.S. Romih

Community Medicine, Women's Health Center, Orthopedic Department,Assiut University Hospitals, Assiut, Egypt.


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Depo-Provera (depot medroxyprogesterone acetate orDMPA intramuscular injection (150 mg/mL), given once

every 3 months exerts its contraceptive effect through the

inhibition of gonadotropin secretion, which in turn prevents

follicular maturation and ovulation and results in endometrial

thinning [Westhoff C. (2003)].


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Several studies suggested that DMPA decreases bone

mineral density in reproductive-age women [Sholes et

al, 2002 Cundy et al ,1991]. Adverse effects on bone

mass acquisition may lead to osteoporosis and relatedmorbidity in later years.

However, studies that have assessed bone mineraldensity (BMD) following discontinuation of DMPA either

have observed recovery [Andrew et al 2008] or have

found no significant differences in BMD between past

users of DMPA and those who never used DMPA [Clark

et al,2006].


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Low socio-economic status was found to be a risk

factor for osteoporosis in different communities [Vu

TT et al,2005]. Also, osteoporotic fractures were

higher in poorer women [Navarro et al 2009].

Moreover, BMD was lower in Middle Eastern

countries than the US or European standards with

the exception of Kuwait [Maalouf ,2007].


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Since women with low socioeconomic class may becharacterized by low dietary intake of calcium necessaryfor bone health, this issue is of particular concern becauseof the lower possibility of recovery of bone mass after

discontinuation

Prevention of bone loss prior to menopause will allow

women to start menopause with a greater bonemass, thus reducing their risk of postmenopausalosteoporosis


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` The aim of this study was to evaluate the effect of

DMPA use on BMD among low socioeconomic

classes in a rural community in Upper Egypt.


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` Cross sectional study among eligible women

using DMPA and non hormonal contraceptive

methods at the family planning clinics in Tema

District and four more villages inS

ohagGovernorate, Upper Egypt.


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Currently lactating or lactation that ended during last 6 months

Recent pregnancy that ended during last 6 months

Current use for more than 3 months of drugs known to be riskfactors of low bone mineral density such as anticonvulsants,corticosteroids, thyroid supplement, thyroid suppressants andthiazide

Chronic diseases affecting bone metabolism such as liverdisease, diabetes mellitus hyper/hypothyroidism, and hyper/hypoparathyroidism;


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Sample Size286

DMPA users150

Non HormonalMethods

136


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` Structured Questionnaire was administered by

personal interviews to collect information about:

-Demographic characteristics,-Reproductive history and lactation history.

-Dietary habits, history of contraceptive use.


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` The social score was measured for each

participant according to Fahmy and El Sherbeny

model II scoring, 1983 .

` This tool was resorted to because of the difficulty

to get information about the percapita

income/month from rural population.


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` 1- Education of father

` - Read and writ / illiterate

` - Primary education

` - Preparatory education

` - Secondary education

` - University or higher

` 2- Education and work of mother

` - Read and writ illiterate, non working

` - Read and writ or illiterate, working

` - Primary education, non working

` - Primary education, working` - Preparatory education, non working

` - Preparatory education, working

` - Secondary education, non working

` - Secondary education, working

` - University education, non working

` - Secondary education, working

` 3- Family size:

` - 3 and 4 members

` - 5 members

` - 6 members

` - 7 or more

2

4

6

810

1

2

3

4

5

6

7

8

9

10

8

6

4

0


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` 4- Sanitation:

` A- water supply:

` - Pure water supply inside house all day

` - Pure water supply inside house sometimes and stored in zeir

` - Common tap outside stored in zeir` - From the canal

` B-Refuse disposal:

` - Collected and thrown in front of house uncovered

` - Collected and thrown in front of house covered

` - Collected and thrown away from house in

a special collecting space

` C- latrines:

` - Present and properly used

` - Present and improperly used

` - Absent 0

` D- Sewage disposal:

` - In an accepted hygienic system

`

- In an unaccepted hygienic system` E- Illumination:

` - Electricity mainly

` -Gas lamp mainly

` - Kerosene mainly

6

4

21

1

2

4

6

3

5

1

4

2

1


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` 5- Information tools inside the house

` Radio, television and video

` - Two of them

` - One of them

` - None

` The total score summed: 57

- igh social standard 50- 57- Middle social standard 40- 49

- Low social standard 30- 39

- Very low social standard


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` Ultrasonographic bone densitometry was done at

the left calcaneous for the participants during

March 2009.

` Anthropometric measurements were done tocalculate BMI for all participants.


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Results


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P valueNon hormonal

methods (n=136)

DMPA(n=150)Character

0.86

0.65

0.78

0.96

0.85

0.74

0.12

0.18

0.18

34.02 7.8

22-48

13.5 1.3

18.8 3.4

5.0 2.8

5.2 1.9

7.8 3.9

31.256.43

4 (5.6%)

71(52.2 %)

30(22.1 %)

35(25.7 %)

34.6 7.00

20-50

13.6 1.2

19.52.87

5.8 2.7

5.032.4

8.2 3.6

30.18 5.14

2 (1.9%)

104 (69.3%)

34 (22.7%)

12 (8 %)

Age (years)

Range of age (years)

Age at menarche

Age at first pregnancy

Number of pregnancies

Breastfed infants

Duration of lactation (years)

BMI

Family history of Osteoporosis

Socio-economic class

Low

Middle

High


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3-520-1Social Class

37 (21.1%)Low class(n=175)

21 (32.8%)20 (31.3%)23 (35.9%)Middle class

(n=64)

14 (29.8%)18 (38.3%)15(31.9%)High class

(n=47)

108 (62%) 30 (17%)


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P

value

NON HORMONAL

METHODS

(n=136)

DMPA

(n=150)

Social Class

Low -1.06 0.78 -0.37 0.99 0.000

Middle -0.97 0.93 -0.40 0.88 0.001

High - 0.66 0.99 -0.40 0.69 0.33


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P

value

NON HORMONAL

METHODS

(n=71)

DMPA(n=104)Duration

of use

t-scoreNo.t-scoreNo.

-0.43 1.15

-0.22 0.74

0.60 0.98

-0.28 0.99

20

14

19

19

-0.71 0.95

-0.97 0.79

-1.16 0.73

-1.24 0.66

19

15

49

32

< 1 year

1-2 years

2-5 years

> 5 years

0.05

0.01

0.001

0.41


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2

0

0

-1

-3

-2

1

2 4 6 1210

Duration of use (years)

T

sco

re


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` Caution has to be exercised in prescribing DMPA

for women of low socioeconomic status and

especially for long periods.

Adapting short term DMPA use and healthawareness of adverse effects may be more

convenient approaches among these classes.


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` More researches are needed regarding BMD recovery

after discontinuation of DMPA in low socioeconomic

class.

` More researches are needed regarding incidences of

postmenopausal bone fractures in past users of DMPA


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Documents

Last Bone Mineral Density and DMPA Use in Low