J Clin Gynecol Obstet

Journal of Clinical Gynecology and Obstetrics, ISSN 1927-1271 print, 1927-128X online, Open Access

Article copyright, the authors; Journal compilation copyright, J Clin Gynecol Obstet and Elmer Press Inc

Journal website http://www.jcgo.org

Original Article

Volume 7, Number 3-4, November 2018, pages 63-68

Depot Medroxyprogesterone Acetate and Bone Mineral Density

**Table 1.** The Characteristics for the Study Cohort at the Time of Their First DXA
	DMPA users (n = 102)	Reference group (n = 204)	P
DXA: dual-energy X-ray absorptiometry; DMPA: depot medroxyprogesterone acetate; BMI: body mass index (kg/m²); BMD: bone mineral density.
Mean age (SD)	37.6 (8)	38.1 (8.2)	0.623
Mean BMI (SD)	26.7 (6.0)	26.3 (5.4)	0.591
Smoking status (n (%))			< 0.001
Current/ex-smoker	23 (22.5)	67 (32.8)
Never smoked	54 (52.9)	135 (66.2)
Unknown	25(24.5)	2 (1.0)
Median months of DMPA use before first DXA (IQR)	52 (31 - 80)	N/A
First DXA scan results
Total hip
Areal BMD (g/cm²)	0.925 ± 0.177	0.996 ± 0.146	< 0.001
Neck of femur
Areal BMD (g/cm²)	0.806 ± 0.151	0.877 ± 0.117	< 0.001
Lumbar spine
Areal BMD (g/cm²)	1.014 ± 0.132	1.101 ± 0.153	< 0.001

Table 1. The Characteristics for the Study Cohort at the Time of Their First DXA

DMPA users (n = 102)

Reference group (n = 204)

DXA: dual-energy X-ray absorptiometry; DMPA: depot medroxyprogesterone acetate; BMI: body mass index (kg/m²); BMD: bone mineral density.

Mean age (SD)

37.6 (8)

38.1 (8.2)

0.623

Mean BMI (SD)

26.7 (6.0)

26.3 (5.4)

0.591

Smoking status (n (%))

< 0.001

Current/ex-smoker

23 (22.5)

67 (32.8)

Never smoked

54 (52.9)

135 (66.2)

Unknown

25(24.5)

2 (1.0)

Median months of DMPA use before first DXA (IQR)

52 (31 - 80)

N/A

First DXA scan results

Total hip

Areal BMD (g/cm²)

0.925 ± 0.177

0.996 ± 0.146

< 0.001

Neck of femur

Areal BMD (g/cm²)

0.806 ± 0.151

0.877 ± 0.117

< 0.001

Lumbar spine

Areal BMD (g/cm²)

1.014 ± 0.132

1.101 ± 0.153

< 0.001

**Table 2.** Crude and Adjusted Annualised BMD Changes (During DMPA Use for Cases) Intended to Show the Impact of DMPA on Bone Measures as Change per Year of Follow-Up (Only Those With at Least Two Visits Included)
	Crude	Adjusted‡
Twenty patients had a DXA scan only post treatment cessation. ‡Adjusted for age, smoking status and BMI. DXA: dual-energy X-ray absorptiometry; DMPA: depot medroxyprogesterone acetate; BMD: bone mineral density. *Five participants had missing data related to their smoking status and therefore they were not included in the adjusted analysis.
Median (IQR) change in aBMD (g/cm²) per year of follow-up
Total hip	0 (-0.006 to 0.006)	-0.0016 (-0.0065 to 0.005)	0.504	0.001 (-0.001 to 0.003)	0.0005 (-0.004 to 0.003)	0.698
Femoral neck	-0.0024 (-0.0118 to 0.0012)	-0.0063 (-0.0109 to 0.0015)	0.718	-0.003 (-0.004 to 0.003)	-0.0043 (-0.006 to -0.002)	0.016
Lumbar spine	-0.0545 (-0.0848 to -0.0267)	-0.0809 (-0.1073 to -0.0427)	0.014	-0.083 (-0.087 to -0.080)	-0.0825 (-0.874 to -0.0790)	0.150
Median (IQR) percent change in BMD (g/cm²) per year of follow-up (%)
Total hip	0 (-0.6 to 0.6)	-0.2 (-0.7 to 0.5)	0.580	0.1 (-0.4 to 0.4)	0.2 (-0.04 to 0.4)	0.445
Femoral neck	-0.3 (-1.5 to 0.1)	-0.8 (-0.1 to 0.2)	0.651	-0.4 (-0.5 to -0.3)	-0.5 (-0.7 to -0.2 )	0.445
Lumbar spine	-4.9 (-9.0 to -2.6)	-7.0 (-11.3 to -4.4)	0.045	-7.7 (-8.0 to -7.0)	-7.7 (-8.0 to -7.3)	0.781

Table 2. Crude and Adjusted Annualised BMD Changes (During DMPA Use for Cases) Intended to Show the Impact of DMPA on Bone Measures as Change per Year of Follow-Up (Only Those With at Least Two Visits Included)

Crude

Adjusted‡

DMPA users† (n = 31)

Reference group (n = 62)

DMPA users† (n = 26)*

Reference group (n = 57)

Twenty patients had a DXA scan only post treatment cessation. ‡Adjusted for age, smoking status and BMI. DXA: dual-energy X-ray absorptiometry; DMPA: depot medroxyprogesterone acetate; BMD: bone mineral density. *Five participants had missing data related to their smoking status and therefore they were not included in the adjusted analysis.

Median (IQR) change in aBMD (g/cm²) per year of follow-up

Total hip

0 (-0.006 to 0.006)

-0.0016 (-0.0065 to 0.005)

0.504

0.001 (-0.001 to 0.003)

0.0005 (-0.004 to 0.003)

0.698

Femoral neck

-0.0024 (-0.0118 to 0.0012)

-0.0063 (-0.0109 to 0.0015)

0.718

-0.003 (-0.004 to 0.003)

-0.0043 (-0.006 to -0.002)

0.016

Lumbar spine

-0.0545 (-0.0848 to -0.0267)

-0.0809 (-0.1073 to -0.0427)

0.014

-0.083 (-0.087 to -0.080)

-0.0825 (-0.874 to -0.0790)

0.150

Median (IQR) percent change in BMD (g/cm²) per year of follow-up (%)

Total hip

0 (-0.6 to 0.6)

-0.2 (-0.7 to 0.5)

0.580

0.1 (-0.4 to 0.4)

0.2 (-0.04 to 0.4)

0.445

Femoral neck

-0.3 (-1.5 to 0.1)

-0.8 (-0.1 to 0.2)

0.651

-0.4 (-0.5 to -0.3)

-0.5 (-0.7 to -0.2 )

0.445

Lumbar spine

-4.9 (-9.0 to -2.6)

-7.0 (-11.3 to -4.4)

0.045

-7.7 (-8.0 to -7.0)

-7.7 (-8.0 to -7.3)

0.781

**Table 3.** Difference in BMD Measures Between Cases and Control at Last DXA for the Reference Group and Last DXA Scan Post DMPA Cessation for Cases
	Crude	Adjusted†
The median (IQR) between first and last DXA after DMPA cessation was 4.1 (2.3 - 5.2) years (n = 13). †Adjusted for age, smoking status and BMI. DXA: dual-energy X-ray absorptiometry; DMPA: depot medroxyprogesterone acetate; BMD: bone mineral density.
Hip	0.858 (0.804 - 0.992)	0.993 (0.935 - 1.073)	< 0.001	0.959 (0.930 - 1.014)	0.973 (0.952 - 1.010)	0.089
Femoral neck	0.74 (0.676 - 0.803)	0.862 (0.787 - 0.944)	< 0.001	0.830 (0.792 - 0.886)	0.858 (0.828 - 0.903)	0.007
Spine	0.972 (0.894 - 1.053	1.084 (1.001 - 1.186)	< 0.001	1.059 (1.041 - 1.083)	1.075 (1.059 - 1.101)	0.002

Table 3. Difference in BMD Measures Between Cases and Control at Last DXA for the Reference Group and Last DXA Scan Post DMPA Cessation for Cases

Crude

Adjusted†

DMPA users (n = 42)

Reference group (n = 204)

Cases (n = 42)

Reference group (n = 202)

The median (IQR) between first and last DXA after DMPA cessation was 4.1 (2.3 - 5.2) years (n = 13). †Adjusted for age, smoking status and BMI. DXA: dual-energy X-ray absorptiometry; DMPA: depot medroxyprogesterone acetate; BMD: bone mineral density.

Hip

0.858 (0.804 - 0.992)

0.993 (0.935 - 1.073)

< 0.001

0.959 (0.930 - 1.014)

0.973 (0.952 - 1.010)

0.089

Femoral neck

0.74 (0.676 - 0.803)

0.862 (0.787 - 0.944)

< 0.001

0.830 (0.792 - 0.886)

0.858 (0.828 - 0.903)

0.007

Spine

0.972 (0.894 - 1.053

1.084 (1.001 - 1.186)

< 0.001

1.059 (1.041 - 1.083)

1.075 (1.059 - 1.101)

0.002