depository medroxyprogesterone acet...

depository medroxyprogesterone acetate (DMPA) is a popular contraceptive [i]modus operandi[/i] because it is effective, convenient, and reversible. DMPA (Depo-Provera) works at suppressing ovulation and ovarian production of estrogen This reduction of estrogen plains has been shown to render bone mass when used through the long term. In adult women this bone mass los can be recruited when women stop using DMPA and their estrogen evens are restored. However, concerns have been raised that DMPA in adolescent patients may have an adverse purport on bone growth because these patients have not attained maximal bone mass. This potential decrease in maximal bone mass may have a significant impact forward bone fracture risk as these patients age. Cromer and colleagues evaluated the use of monthly injections of estradiol cypionate in adolescents who receive DMPA and its potential benefit forward bone mineral density.

The trial was a double-blind, placebo-controlled, randomized reflection of adolescent females from 12 to 18 years of age who were seeking contraception. Exclusion criteria included the use of DMPA, pregnancy or abortion during the past six month the use of oral contraception through the past three months, or a treatment or medical condition that may affect bone mineral density. Before the randomization, participants were stratified at recruitment site, race, and number of years since menarche (i.e., three years or les or more than three years). All of the participants received DMPA 150 mg intramuscularly each 12 weeks with an intramuscular injection of 5 mg estradiol cypionate or placebo onward a monthly basis. Participant information gathered included tobacco use, calcium intake, physical activity, and menstrual bleeding pattern. Height and weight were measured before the start of the thought Bone mineral density was evaluated using a dual life x-ray absorptiometry scan at baseline and at 12 and 24 month using standardized techniques. The main result measure was bone mineral density at the period of 24 months.

The trial design was as it was that at the end of 12 month if the differences in bone mineral density between the active treatment and placebo clumps were significant, the trial would be stopped. Because the evens did reach significance at 12 month the trial was stopped and those in the placebo assign places to were offered estradiol treatment. At 12 month those in the DMPA plus estradiol clump had an increase in bone mineral density at the lumbar spine of 10 percent whereas those upon DMPA plus placebo had a decrease of 22 percent a significant difference. There was no significant difference in femoral neck mineral density at 12 month between the couple groups. The number of participants who complet the 24-month investigation was 19 in the DMPA-plus-estradiol assign places to and 17 in the DMPA-plus-placebo dispose At 24 months, when adjusting for dead body weight and baseline bone density, the dispose that received DPMA plus estradiol had an increase in bone mineral density at the lumbar spine of 28 percent whereas those receiving DMPA plus placebo had a decrease in bone mineral density of 18 percent The change at the femoral neck was an increase of 47 percent in the DMPA-plus-estradiol collection whereas the DMPA-plus-placebo group had a decrease of 51 percent one as well as the other changes were statistically significant.

The authors finish that estrogen supplementation may be protective of bone mineral density in adolescents who use DMPA injections for contraception. They add that further research emergencys to be performed to address the regaining of bone mineral density after discontinuing DMPA in adolescents; they also allude to evaluating the impact diet and exercise may have onward this recovery.

KARL E MILLER, MD Cromer BA, et al. Double-blinded randomized controll trial of estrogen supplementation in adolescent girls who receive station-house medroxyprogesterone acetate for contraception. Am J Obstet Gynecol January 2005;192:42-7

EDITOR'S NOTE: Long-term use of depository medroxyprogesterone acetate (DMPA) has been shown to have a negative impact upon bone mineral density, and there is a certain number of concern that this loss may not be completely reversible after discontinuing the mix with drugs This concern has led the U regimen and Drug Administration to commit that a black box warning be added to the remedy information. 1 The warning states that DMPA contraceptive injection should be used lengthy term (longer than two years) single in women in whom other birth superintend methods are inadequate. (1) The above meditation by Cromer and associates demonstrated that the addition of estrogen to DMPA may shape the negative impact on bone mineral density.--K.E.M.

REFERENCE

(1) U aliment and Drug Administration. Black driver's seat warning added concerning long-term use of Depo-Provera contraceptive injection. Accessed online November 17 2004 at: http://www.fda.gov/bbs/topics/ANSWERS/2004/ ANS01325.html.

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