DEPO-PROVERA USE AND BONE MINERAL DENSITY IN YOUNG WOMEN

骨质疏松症和相关的骨折是日益严重的公共卫生问题。 影响晚年骨丢失的因素和影响峰值骨的因素 大规模普及是预防这种情况的关键。 几个小 研究表明长效醋酸甲羟孕酮（Depo-Provera， DMPA）是一种注射用的甾酮避孕药， 密度，并可能因此增加妇女以后患骨质疏松症的风险。 然而，我们正在进行的一项大型研究中对这种关联的评估， 研究小组提供的证据表明，DMPA的影响可能更复杂， 年龄、使用时间和解剖部位。 特别是， 在年轻的年龄组中，骨骼可能更大。初步研究还 表明停药可能对骨量产生有利影响，但是否 任何影响都是完全相反的，什么角色的年龄，持续时间 既往DMPA使用、停药后的时间和其他协变量可能 目前还不清楚这场比赛的情况。 我们建议继续进行前瞻性流行病学评估， DMPA使用对育龄妇女骨密度的影响 妇女 主要目的是：在以下地区实现长期BMD评估： 继续使用这种避孕方法的妇女;评估 在不同年龄和使用持续时间的女性中停药的影响; 探讨DMPA对青少年骨密度的影响。 成员 在我们已建立的457名18-39岁女性队列中， 随后更全面地评估继续使用DMPA对 骨密度，并评估停药后BMD的变化。 我们 我建议增加一批青少年， 参与者 这一组将从同一个定义的HMO招募 人口作为我们正在进行的研究小组，使用自动化数据库， 选择DMPA使用者和随机选择的年龄相当的妇女不使用 DMPA。青少年妇女将被随访24至36个月。 为所有 参与者的主要结果，骨矿物质密度，将被测量 每6个月在不同解剖部位（髋关节、脊柱和全身） 使用双能X射线吸收法。 这项建议涉及一个指定为优先研究的领域 由NIH/NICHD和纳入一组（青少年）被认为是在 需要充分的研究。 此外，DMPA越来越成为 在年轻避孕妇女中流行的避孕药。 尺寸， 多样性和DMPA暴露的范围， 综合评估可能存在的复杂关联， 这种有效、方便、经济的避孕方法和骨质疏松症。

Osteoporosis and related fractures are growing public health problems. Factors affecting bone loss in later life and those affecting peak bone mass attainment are key to prevention of this condition. Several small studies suggest that depot medroxyprogesterone acetate (Depo-Provera, DMPA), an injectable progesterone-based contraceptive, decreases bone density and may thus increase a woman's later risk of osteoporosis. However, our ongoing evaluation of this association in a large study group provides evidence that DMPA's effects may be more complex, varying by age, duration of use, and anatomic site. In particular, effects on bone may be greater in younger age groups. Preliminary studies also suggest that discontinuation may favorably impact bone mass, but whether any effects are completely reversed and what roles age, duration of prior DMPA use, time since discontinuation, and other covariates may play is, as yet, unclear. We propose to continue our prospective epidemiologic evaluation of the effects of DMPA use on bone mineral density (BMD) in reproductive-age women. The primary aims are: to attain longer-term BMD evaluations in women who continue to use this contraceptive method; to assess the effects of discontinuation in women of varying age and durations of use; and to evaluate DMPA's effects on bone density in adolescents. Members of our established cohort of 457 women 18-39 years of age will be followed to evaluate more fully the effects of continued DMPA use on bone density and to assess changes in BMD after discontinuation. We propose to enrich our cohort with an additional group of adolescent participants. This group will be recruited from the same defined HMO population as our ongoing study group, using automated databases to select DMPA users and randomly-selected age-comparable women not using DMPA. Adolescent women will be followed for 24 to 36 months. For all participants the primary outcome, bone mineral density, will be measured every 6 months at various anatomic sites (hip, spine, and whole body) using dual-energy x-ray absorptiometry. This proposal addresses an area designated as a priority for research by the NIH/NICHD and incorporates a group (adolescents) deemed to be in critical need of adequate study. Moreover, DMPA is an increasingly popular contraceptive among young contracepting women. The size, diversity, and range of DMPA exposure in this study group allow for comprehensive evaluation of the possibly complex association between this effective, convenient and economical contraceptive and bone mass.