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UNLABELLED: Prospective cohort study performed to evaluate bone mineral density (BMD) changes up to 12 months postpartum of healthy women and its association with breastfeeding, contraceptive methods, amenorrhea, and body mass index (BMI). There is a trend in bone loss during the first 6 months with posterior recovery, with evidence of a protective effect of hormonal contraception. INTRODUCTION: This study was conducted to evaluate bone mineral density (BMD) changes during postpartum period among healthy women and its association with breastfeeding, use of contraceptive methods, amenorrhea and body mass index (BMI). METHODS: A prospective cohort study including 100 healthy women. Distal BMD was measured 7-10 days, 3, 6, and 12 months postpartum at the nondominant forearm using dual-energy X-ray absorptiometry. Data about breastfeeding duration, amenorrhea, contraceptive use and BMI were collected. RESULTS: Seventy-eight women had a complete set of BMD measurements. The mean duration of exclusive breastfeeding was 125.9 (±66.6) days, with a median total lactation period of 263.5 days. The mean duration of amenorrhea was 164.2 (±119.2) days. BMD measurements showed a significant decrease in the distal radius, however with no significance in the ultradistal radius. When considering only the nonhormonal contraceptive users, the difference at 12 months was significant. Multivariate analysis of variance showed that both BMI and contraceptive use were significantly correlated with BMD. Multiple linear regression analysis showed significant correlation of distal radius with baseline BMD at the same site, pregestational BMI, age, years of schooling and difference in BMI. For ultradistal radius, there was a significant direct correlation with its baseline BMD and pregestational BMI. CONCLUSIONS: There was a trend in bone loss during the first 6 months postpartum with posterior recovery. Also, hormonal contraceptive methods provided protection of bone loss. However, the long duration of breastfeeding and the follow-up were not sufficient to draw definitive conclusions on postweaning BMD conditions.

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BACKGROUND: There are many controversies on the association between depot medroxyprogesterone acetate (DMPA) and bone mineral density (BMD). This study reevaluated BMD in postmenopausal women who had used DMPA as a contraceptive until they reached menopause and compared them with non-users. BMD had previously been measured in these women either at 1 year or 2-3 years after menopause and was reassessed in these women 2 years later. Therefore, comparisons were made between the first and third years and between the second to third and fourth to fifth years after menopause. STUDY DESIGN: BMD was reevaluated using dual-energy X-ray absorptiometry at two parts of the non-dominant forearm up to 5 years after menopause in 79 women between 46 and 61 years old: 24 former DMPA users and 55 former copper intrauterine device (IUD) users. RESULTS: With respect to the former DMPA users, only the BMD measurement at the distal radius in the first year (mean±SEM, 0.425±0.017) was significantly higher than the third-year measurement (0.406±0.017) (p<.015). No significant differences were found at the ultradistal radius. There were no significant differences between the groups of former DMPA and IUD users with respect to BMD measurements either at the distal radius or at the ultradistal radius. There was a direct relationship between higher body mass index (kg/m(2)) and higher BMD at the distal radius between the first and third years. At the ultradistal radius, there was an indirect relationship between older age and lower BMD between the first and third years in both groups. CONCLUSIONS: No statistically significant differences were found in forearm BMD measurements between postmenopausal women who had been long-term users of DMPA and those who had been long-term users of an IUD until menopause. Evaluation of BMD after the menopause showed slightly higher values in former DMPA users compared with non-users.

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BACKGROUND: The aim of the study was to compare bone mineral density (BMD) before insertion and at 18 months of use of etonorgestrel- and levonorgestrel-releasing contraceptive implants. METHODS: One hundred and eleven women, 19-43 years of age, were randomly allocated to two groups: 56 to etonorgestrel and 55 to levonorgestrel. BMD was evaluated at the midshaft of the ulna and at the distal radius of the non-dominant forearm using dual-energy X-ray absorptiometry before insertion and at 18 months of use. RESULTS: There was no difference in baseline demographic or anthropometric characteristics, or in BMD of users of either model of implant. BMD was significantly lower at 18 months of use at the midshaft of the ulna in both groups of users. However, no difference was found at the distal radius. Multiple linear regression analysis showed that the variables associated with BMD at 18 months of use in both implant groups were baseline BMD, body mass index (BMI) and difference in BMI (0 versus 18 months of use). CONCLUSIONS: Women of 19-43 years of age using either one of the implants showed lower BMD at 18 months of use at the midshaft of the ulna, however, without a difference at the distal radius.

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OBJECTIVE: To determine the influence of depot medroxyprogesterone acetate (MPA) on bone mineral density when used as a contraceptive method. DESIGN: Cross-sectional study. SETTING: Academic tertiary-care hospital. PATIENT(S): Fifty premenopausal women who had used depot MPA as a contraceptive method for > or =1 year and 50 women who had never used hormonal contraceptive methods. INTERVENTION(S): Bone mineral density was evaluated at the midshaft and at the distal radius of the nondominant forearm using single x-ray absorptiometry. MAIN OUTCOME MEASURE(S): Bone mineral density. RESULT(S): Bone mineral density at the midshaft of the forearm was lower in depot MPA users than in women who had never used hormonal contraceptive methods, but the difference was not statistically significant. At the distal portion, bone mineral density was significantly lower in the study group. The duration of depot MPA use was not related to bone mineral density. CONCLUSION(S): Women > or =35 years of age presented with a lower bone mineral density only at the distal portion of the forearm after the use of depot MPA for > or =1 year. However, this decrease was not related to the duration of depot MPA use. It is not possible to conclude that women who use depot MPA are at risk of osteoporosis.

PIP: The impact of depot medroxyprogesterone acetate use on bone mineral density was assessed in a cross-sectional study of 100 women recruited from a teaching hospital in Campinas, Brazil, during 1996-98. Bone mineral density, as evaluated at the midshaft and distal radius of the nondominant forearm by single x-ray absorptiometry, was compared in 50 women 35-45 years of age who had been using Depo-Provera for contraception for 1 year or more (mean duration, 46.4 +or- 38.6 months) but had never used any other hormonal method and 50 age- and weight-matched women who had never used any form of hormonal contraception. Although mean bone mineral density at the midshaft of the forearm was lower in Depo-Provera users than nonusers of hormonal contraception (0.459 +or- 0.042 vs. 0.474 +or- 0.049 g/sq. cm), the difference was not statistically significant. At the distal portion, bone mineral density was significantly lower in Depo-Provera users than nonusers of hormonal methods (0.362 +or- 0.040 vs. 0.392 +or- 0.049 g/sq. cm, p 0.001). The duration of Depo-Provera use was not related to bone mineral density, even when women had used the method for more than 5 years. Multiple regression analysis indicated that 4 pregnancies, White race, and Depo-Provera use were significantly associated with lower bone mineral density at the midshaft section of the forearm; at the distal section of the forearm, these variables were Depo-Provera use, more than 4 pregnancies, White race, older age at menarche, and habitual coffee drinking. These findings do not provide sufficient evidence to conclude that Depo-Provera users are at increased risk of osteoporosis.

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