m
  

  
   
 



 

 

Community Medicine, Women's Health Center, Orthopedic Department,

Assiut University Hospitals, Assiut, Egypt.
Depo-Provera ® (depot medroxyprogesterone acetate or
DMPA intramuscular injection (150 mg/mL), given once
every 3 months exerts its contraceptive effect through the
inhibition of gonadotropin secretion, which in turn prevents
follicular maturation and ovulation and results in endometrial
thinning K
 
 
Oeveral studies suggested that DMPA decreases bone
mineral density in reproductive-age women K





   Adverse effects on bone
mass acquisition may lead to osteoporosis and related
morbidity in later years.

However, studies that have assessed bone mineral

density (BMD) following discontinuation of DMPA either
have observed recovery K

 
 or have
found no significant differences in BMD between past
users of DMPA and those who never used DMPA K

 

 Low socio-economic status was found to be a risk
factor for osteoporosis in different communities K

 
! Also, osteoporotic fractures were
higher in poorer women [Navarro et al 2009].
Moreover, BMD was lower in Middle Eastern
countries than the UO or European standards with
the exception of Kuwait K" 
#
4 Oince women with low socioeconomic class may be
characterized by low dietary intake of calcium necessary
for bone health, this issue is of particular concern because
of the lower possibility of recovery of bone mass after
discontinuation

4 Prevention of bone loss prior to menopause will allow

women to start menopause with a greater bone
mass, thus reducing their risk of postmenopausal
osteoporosis
` Èhe aim of this study was to evaluate the effect of
DMPA use on BMD among low socioeconomic
classes in a rural community in Upper Egypt.
` Cross sectional study among eligible women
using DMPA and non hormonal contraceptive
methods at the family planning clinics in Èema
District and four more villages in Oohag
Governorate, Upper Egypt.
4 Currently lactating or lactation that ended during last 6 months

4 ecent pregnancy that ended during last 6 months

4 Current use for more than 3 months of drugs known to be risk

factors of low bone mineral density such as anticonvulsants,
corticosteroids, thyroid supplement, thyroid suppressants and
thiazide

4 Chronic diseases affecting bone metabolism such as liver

disease, diabetes mellitus hyper/hypothyroidism, and hyper/
hypoparathyroidism;
 O
O



 
 




` Otructured Questionnaire was administered by

personal interviews to collect information about:

-Demographic characteristics,
- eproductive history and lactation history.
-Dietary habits, history of contraceptive use.
` Èhe social score was measured for each
participant according to Fahmy and El Oherbeny
model II scoring, 1983 .

` Èhis tool was resorted to because of the difficulty

to get information about the percapita
income/month from rural population.
` =     2
` - ead and writ / illiterate 4
` - Primary education
6
` - Preparatory education
8
` - Oecondary education
` - University or higher 10
` 2     
` - ead and writ illiterate, non working 1
` - ead and writ or illiterate, working 2
` - Primary education, non working 3
` - Primary education, working 4
` - Preparatory education, non working
5
` - Preparatory education, working
` - Oecondary education, non working 6
` - Oecondary education, working 7
` - University education, non working 8
` - Oecondary education, working 9
` þ  
 10
` - 3 and 4 members
` - 5 members
8
` - 6 members
6
` - 7 or more
4
0
`    
` A- water supply: 6
` - Pure water supply inside house all day
4
` - Pure water supply inside house sometimes and stored in zeir
` - Common tap outside stored in zeir 2
` - From the canal 1
` V -Refuse disposal:
` - Collected and thrown in front of house uncovered 1
` - Collected and thrown in front of house covered
2
` - Collected and thrown away from house in
a special collecting space 4
` @- latrines:
` - Present and properly used 6
` - Present and improperly used 3
` - Absent 0
` m- Sewage disposal:
` - In an accepted hygienic system 5
` - In an unaccepted hygienic system 1
` - Illumination:
` - Electricity mainly 4
` -Gas lamp mainly
2
` - Kerosene mainly
1
` °
   
  
` adio, television and video 6
` - Èwo of them 4
` - One of them 2
` - None 0

` È 
 °

- igh social standard 50- 57

- Middle social standard 40- 49
- Low social standard 30- 39
- Very low social standard <30
` Ultrasonographic bone densitometry was done at
the left calcaneous for the participants during
March 2009.

` Anthropometric measurements were done to

calculate BMI for all participants.
esults
 Character DMPA(n=150) Non hormonal P value
methods (n=136)
Age (years) 34.6 ± 7.00 34.02 ± 7.8 0.86
ange of age (years) 20-50 22-48
Age at menarche 13.6 ± 1.2 13.5 ± 1.3 0.65
Age at first pregnancy 19.5±2.87 18.8 ± 3.4 0.78
Number of pregnancies 5.8 ± 2.7 5.0 ± 2.8 0.96
Breastfed infants 5.03±2.4 5.2 ± 1.9 0.85
Duration of lactation (years) 8.2 ± 3.6 7.8 ± 3.9 0.74
BMI 30.18 ±5.14 31.25±6.43 0.12
Family history of Osteoporosis 2 (1.9%) 4 (5.6%) 0.18
Oocio-economic class
Low 104 (69.3%) 71(52.2 %)
Middle 34 (22.7%) 30(22.1 %) 0.18
High 12 (8 %)
35(25.7 %)

!
 =
þ°

Low class 37 (21.1%)

(n=175)  
  

Middle class 23 (35.9%) 20 (31.3%) 21 (32.8%)

(n=64)

High class 15(31.9%) 18 (38.3%) 14 (29.8%)

(n=47)

!
 m˜ ###$ ˜
% &=° Èm "

% &=þ

ð!"#
± # "# ± #$$#

"#$ ± #$"#%± # #

&" #

±#$$"#%± #
$#
Duration DMPA(n=104) NON HO MONAL P
MEÈHODO
of use value
(n=71)

No. t-score No. t-score

< 1 year 19 -0.71 ± 0.95 20 -0.43 Ô 1.15 #%

1-2 years 15 -0.97 ± 0.79 14 -0.22 Ô 0.74 #

2-5 years 49 -1.16 ± 0.73 19 0.60 Ô 0.98 #

> 5 years 32 -1.24 ± 0.66 19 -0.28 Ô 0.99 #

)


*






"

"

"

  %
 
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`Caution has to be exercised in prescribing DMPA
for women of low socioeconomic status and
especially for long periods.
Adapting short term DMPA use and health
awareness of adverse effects may be more
convenient approaches among these classes.
` More researches are needed regarding BMD recovery
after discontinuation of DMPA in low socioeconomic
class.

` More researches are needed regarding incidences of

postmenopausal bone fractures in past users of DMPA