DEPO-PROVERA USE AND BONE MINERAL DENSITY IN YOUNG WOMEN

骨质疏松症和相关骨折是日益严重的公共卫生问题。 影响晚年骨丢失的因素及影响峰值骨量的因素 群众素质是预防这种情况的关键。几个小的 研究表明，醋酸甲羟孕酮(Depo-Provera， DMPA)，一种以黄体酮为基础的注射避孕药，减少骨骼 这可能会增加女性日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联系的评估 该组织提供的证据表明，DMPA的影响可能更加复杂、多种多样 按年龄、使用时间和解剖部位分类。特别是，对 在较年轻的人群中，骨骼可能更大。初步研究亦包括 这表明停药可能会对骨量产生有利影响，但是否 任何影响都是完全颠倒的，什么角色的年龄、持续时间 先前使用DMPA、停用后的时间和其他协变量可能 到目前为止，游戏还不清楚。 我们建议继续我们的前瞻性流行病学评估 使用DMPA对育龄妇女骨密度的影响 女人。主要目标是：在#年实现长期的骨密度评估 继续使用这种避孕方法的妇女；评估 停药对不同年龄和服药时间的妇女的影响； 并评价DMPA对青少年骨密度的影响。成员 在我们457名年龄在18-39岁之间的女性中， 以更全面地评估继续使用DMPA对 并评估停药后骨密度的变化。我们 建议增加一组青少年来充实我们的队列 参与者。此组将从相同定义的HMO中招募 作为我们正在进行的研究小组，使用自动化数据库来 选择DMPA用户和随机选择的年龄相当的女性不使用 DMPA。青春期妇女将接受24至36个月的跟踪调查。为所有人 参与者将测量主要结果，即骨密度 每6个月在不同的解剖部位(臀部、脊柱和全身) 使用双能X射线吸收计量仪。 该提案涉及一个被指定为优先研究领域的问题。 由NIH/NICHD提供，并纳入被认为是 迫切需要充分的学习。此外，DMPA是一个日益增长的 在年轻避孕女性中很受欢迎的避孕药。大小， 这个研究组接触DMPA的多样性和范围允许 对可能存在的复杂关联进行综合评估 这种有效、方便、经济的避孕药和骨量。

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.