Bone loss in adolescents using Depo-Provera

Effect of Education on Preventive Behaviors of Osteoporosis in Adolescents: A Systematic Review and Meta-Analysis

BACKGROUND

Osteoporosis is one of the diseases that can be prevented by correcting health behaviors during adolescence.

OBJECTIVE

This study was conducted to evaluate the effect of education on preventive behaviors of osteoporosis including physical activity, calcium intake and practice (primary outcomes) and knowledge and attitude related to osteoporosis (secondary outcomes) in adolescents.

METHOD

A search was done in Cochrane Library, PubMed, Embase, Web of Sciences, Scopus, Google Scholar, SID and Magiran regardless of the time limit. To evaluate the quality of selected controlled trials, Cochrane collaboration' instrument was used for assessing the risk of bias. RevMan software was used to analysis and report the data.

RESULTS

Of 2159 articles retrieved, 20 of them were reviewed and 18 of them entered the mete-analysis. The meta-analysis showed significant differences between the education and control groups in terms of calcium intake (SMD = 0.78, 95%CI = 0.55 to 1.02, P < 0.00001), practice (SMD = 0.54, 95%CI = 0.41 to 0.68, P < 0.0001), knowledge (SMD = 1.76, 95%CI = 1.10 to 2.42, P < 0.00001) and attitude (SMD = 0.96, 95%CI = 0.53 to 1.40, P < 0.0001) mean score in adolescents but education is not effective on average minute/week of physical activity per week (MD = 31.94, 95%CI = -6.53 to 70.40, P = 0.10), mean score of physical activity (MD = 2.66, 95%CI = -0.55 to 5.88, P = 0.10) and percent of students participated in the physical activity (OR = 1.45, 95%CI = 0.30 to 6.91, P = 0.64).

CONCLUSION

Education is effective in improving their knowledge and attitudes toward osteoporosis. It can also improve some health-related behaviors for bone health such as sufficient dairy calcium intake but it has not been effective in establishing a regular exercise program.

Association between depot medroxyprogesterone acetate (DMPA), physical activity and bone health

Physical activity has been advocated for women in the hope of offsetting progestin-only contraceptive-related loss in bone mineral density. There is limited evidence for the beneficial effect of physical activity on bone health of hypo-oestrogenic premenopausal women. The aim of this cross-sectional study was to examine the relationship between physical activity and bone health [as measured by quantitative ultrasound (QUS)] of depot-medroxyprogesterone acetate (DMPA) users, and to investigate whether QUS measurements of DMPA users and non-users differed according to physical activity. Bone health of 48 DMPA users and 48 age-matched controls (22.83 ± 3.2 years) was assessed using calcaneal broadband ultrasound attenuation (BUA). Participants were categorised into low and high levels of physical activity based on their exposure to bone-loading exercise. Analysis of covariance was conducted to determine if QUS measurements of DMPA users and non-DMPA users differed within levels of bone-loading physical activity after controlling for body mass index. The duration of DMPA use ranged from 6 to 132 months. Participants' reference bone-loading exposure time averaged 3.3 ± 1.8 years. Data analysis revealed that DMPA users had significantly lower BUA by 6.54 dB/MHz (t (95) = -2.411, p = 0.018) compared to non-users of DMPA. Concurrently high levels of physical activity and DMPA use led to 1.996 dB/MHz decreases in BUA. A cycle of prolonged DMPA use and concurrent engagement in high levels of physical activity appears detrimental to bone health. It is suggested that the lack of oestrogen may counteract the effects of physical activity by inhibiting bone formation in response to mechanical bone-loading.

Bone mineral density, fracture, and vitamin D in adolescents and young women using depot medroxyprogesterone acetate

STUDY OBJECTIVE

To evaluate bone mineral density (BMD) in adolescents and young adults treated with depot medroxyprogesterone acetate (DMPA).

DESIGN, SETTING, PARTICIPANTS

Eighty-three healthy subjects, 13-20 years old, who received at least 3 DMPA injections in an urban adolescent clinic and underwent dual energy x-ray absorptiometry (DXA) were evaluated by chart review.

MAIN OUTCOME MEASURES

Anthropometric data, DMPA use, BMD of the spine and hip, fracture history, and vitamin D status were collected.

RESULTS

Subjects were a median age of 16.4 years old (range 13-20 years) when DMPA was initiated. The median number of DMPA injections was 5 (range 3-18) before the first DXA. At the spine and hip, respectively, BMD was normal (Z-score > -1.0 SD) for most subjects (79%, 86%). Subjects who received > 5 injections were more likely to have low spinal BMD (Z-score ≤ -2.0 SD) at first DXA (P = .018). In 15 subjects with repeat DXA measurements, after an additional median 6 injections, spinal BMD Z-score decreased by -0.33 ± 0.10 (mean ± SD, P = .004), as did absolute BMD at the hip (-0.019 ± 0.007 g/cm(2), P = .014). History of fracture was not associated with initial or subsequent BMD measurements. Most (12/13, 92.3%) subjects with vitamin D measurements were deficient (25-hydroxy vitamin D < 20 ng/mL).

CONCLUSIONS

Most subjects on DMPA had normal BMD at first DXA. Low spinal BMD was associated with longer DMPA use, and some BMD measurements declined with prolonged use. Fracture history is not an absolute contraindication to DMPA use in this population. Studies are needed to determine possible benefits of vitamin D supplementation in DMPA users.

Bone mineral density in lymphangioleiomyomatosis

Estrogen deficiency and pulmonary diseases are associated with bone mineral density (BMD) loss. Lymphangioleiomyomatosis (LAM), a disorder affecting women that is characterized by cystic lung lesions, is frequently treated with antiestrogen therapy, i.e., progesterone and/or oophorectomy. Therefore, we evaluated BMD yearly in 211 LAM patients to determine the prevalence of BMD abnormalities, whether antiestrogen therapy decreased BMD, and if treatment with bisphosphonates prevented bone loss. Abnormal BMD was found in 70% of the patients and correlated with severity of lung disease and age. Greater severity of lung disease, menopause, and oophorectomy were associated with greater decline in BMD. After adjusting for differences in initial lung function and BMD, we found similar rates of BMD decline in progesterone-treated (n = 122) and untreated patients (n = 89). After similar adjustments, we found that bisphosphonate-treated patients (n = 98) had lower rates of decline in lumbar spine BMD (-0.004 +/- 0.003 vs. -0.015 +/- 0.003 gm/cm(2), p = 0.036) and T-scores (-0.050 +/- 0.041 vs. -0.191 +/- 0.041, p < 0.001) than untreated patients (n = 113). We conclude that abnormal BMD was frequent in LAM. Progesterone therapy was not associated with changes in BMD; bisphosphonate therapy was associated with lower rates of bone loss. We recommend systematic evaluation of BMD and early treatment with bisphosphonates for patients with LAM.

Depot-medroxyprogesterone acetate injection (Depo-Provera): a highly effective contraceptive option with proven long-term safety

Depot-medroxyprogesterone acetate (Depo-Provera(R)) is a highly effective, nondaily hormonal contraceptive option that has been available in the United States for a decade, and worldwide for 40 years. Benefits and risks of hormonal therapy are often under scrutiny; however, long-term clinical experience has established the safety of this long-acting contraceptive. This article reviews the contraceptive efficacy, potential noncontraceptive health benefits and long-term safety of with regard to risk of cardiovascular events, breast and gynecologic malignancy and osteopenia. Comparisons with other hormonal contraceptives are made as clinically appropriate. Common patient management issues, including effects on menstrual cycle, body weight and mood, are also addressed. Finally, this review provides recommendations for appropriate patient selection.