Exploratory study of the effect of lifestyle counselling on bone mineral density and body composition in users of the contraceptive depot-medroxyprogesterone acetate

Abstract

Objectives To compare variations in bone mineral density (BMD) and body composition (BC) in depot-medroxyprogesterone acetate (DMPA) users and nonusers after providing counselling on healthy lifestyle habits.

Methods An exploratory study in which women aged 18 to 40 years participated: 29 new DMPA users and 25 new non-hormonal contraceptive users. All participants were advised on healthy lifestyle habits: sun exposure, walking and calcium intake. BMD and BC were assessed at baseline and 12 months later. Statistical analysis included the Mann-Whitney test or Student's t-test followed by multiple linear regression analysis.

Results Compared to the controls, DMPA users had lower BMD at vertebrae L1 and L4 after 12 months of use. They also had a mean increase of 2 kg in total fat mass and an increase of 2.2% in body fat compared to the non-hormonal contraceptive users. BMD loss at L1 was less pronounced in DMPA users with a calcium intake ≥ 1 g/day compared to DMPA users with a lower calcium intake.

Conclusions DMPA use was apparently associated with lower BMD and an increase in fat mass at 12 months of use. Calcium intake ≥ 1 g/day attenuates BMD loss in DMPA users. Counselling on healthy lifestyle habits failed to achieve its aims.

Chinese Abstract

摘 要 目的 比较健康生活习惯指导对长效醋酸甲羟孕酮应用者和不用者骨密度和体成分影响的差异。

方法 一项针对年龄在18岁至40岁妇女的探索性研究：29名用长效醋酸甲羟孕酮，25名用非激素类避孕。建议所有的参与者都养成健康的生活习惯：晒太阳，散步和摄入钙。在开始和12个月后评估骨密度和体成分。统计分析包括Mann-Whitney检验或多元线性回归分析后行t-检验。

结果 与对照组相比，用长效醋酸甲羟孕酮12个月后，脊椎L1和L4的骨密度较低。与非激素避孕药使用者比，他们的平均总脂肪增加了2kg，并且体内的脂肪增加2.2%；每天摄入1g钙的长效醋酸甲羟孕酮组与较低钙摄入的长效醋酸甲羟孕酮组比，两组L1的骨密度丢失不太明显。

结论 醋酸甲羟孕酮的使用与骨密度降低明显相关，并且用药12个月后脂肪含量增加。使用醋酸甲羟孕酮时，每天摄入1克钙会抑制骨质丢失。健康生活习惯的建议未能实现其目标。

Keywords:

• Depot-medroxyprogesterone acetate
• Bone mineral density
• Body composition

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and the writing of the paper.

The authors received financial support from the Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) [grant # 09/53293-0] and the National Research Council (CNPq) [grant #573747/2008-3]. WM has a fellowship from the Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) [grant # 2011/01554-4].