南非中年长期使用激素避孕者的骨矿物质密度：与肥胖和绝经状态的关系。
Bone mineral density in midlife long-term users of hormonal contraception in South Africa: relationship with obesity and menopausal status.
作者信息
Beksinska Mags E, Kleinschmidt Immo, Smit Jenni A
机构信息
1MatCH Research Unit [Maternal, Adolescent and Child Health Research Unit], Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand, 40 Dr AB Xuma Street,11th floor, Suite 1108-9,Commercial City, Durban, 4001 South Africa.
2London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E England.
出版信息
Womens Midlife Health. 2018 Apr 10;4:6. doi: 10.1186/s40695-018-0035-0. eCollection 2018.
BACKGROUND
In South Africa, hormonal contraception is widely used in women over the age of 40 years. One of these methods and the most commonly used is depot-medroxyprogesterone acetate (DMPA) which has been found to have a negative effect on bone mass. Limited information is available on the effect of norethisterone enanthate (NET-EN) on bone mass, and combined oral contraceptives (COCs) have not been found to be associated with loss of bone mass. The aim of this study was to investigate bone mineral density (BMD) in pre and perimenopausal women (40-49 years) in relation to use of DMPA, NET-EN and COCs for at least 12 months preceding recruitment into the study and review associations with body mass index (BMI) and menopausal status.
METHODS
One hundred and twenty seven users of DMPA, 102 NET-EN users and 106 COC users were compared to 161 nonuser controls. Menopausal status was assessed, BMI and forearm BMD was measured at the distal radius using dual X-ray absorptiometry. Comparison analysis was conducted at baseline and 2.5 years.
RESULTS
There was no significant difference in BMD between the four contraceptive user groups ( = 0.26) with and without adjustment for age at baseline or at 2.5 years ( = 0.52). The BMD was found to be significantly associated with BMI ( = < 0.0001) with an increase of one unit of BMI translating to an increase of 0.0044 g/cm in radius BMD Follicle stimulating hormone (FSH) level ≥ 25.8 mIU/mL was associated with a decrease of 0.017 g/cm in radius BMD relative to women with FSH < 25.8 mIU/mL. Significant interaction between FSH and BMI in their effect on BMD was observed ( = .006).
CONCLUSION
This study found no evidence that long-term use of DMPA, NET-EN and COCs affects forearm BMD in this population at baseline or after 2.5 years of follow-up. This study also reports the complex relationship and significant interaction between FSH and BMI in their effect on BMD. BMD research in older women needs to ensure that women are assessed for menopausal status and BMI.
背景
在南非，40岁以上女性广泛使用激素避孕法。其中一种也是最常用的方法是醋酸甲羟孕酮长效注射剂（DMPA），已发现其对骨量有负面影响。关于庚酸炔诺酮（NET-EN）对骨量影响的信息有限，且未发现复方口服避孕药（COC）与骨量流失有关。本研究的目的是调查在招募进入研究前至少使用DMPA、NET-EN和COC 12个月的绝经前和围绝经期妇女（40 - 49岁）的骨矿物质密度（BMD），并回顾其与体重指数（BMI）和绝经状态的关联。
方法
将127名DMPA使用者、102名NET-EN使用者和106名COC使用者与161名非使用者对照进行比较。评估绝经状态，使用双能X线吸收法测量BMI和桡骨远端的前臂BMD。在基线和2.5年时进行比较分析。
结果
在基线或2.5年时，无论是否对年龄进行调整，四个避孕使用者组之间的BMD均无显著差异（P = 0.26）（P = 0.52）。发现BMD与BMI显著相关（P = < 0.0001），BMI每增加一个单位，桡骨BMD增加0.0044 g/cm。促卵泡生成素（FSH）水平≥25.8 mIU/mL与桡骨BMD相对于FSH < 25.8 mIU/mL的女性降低0.017 g/cm相关。观察到FSH和BMI对BMD的影响存在显著交互作用（P = 0.006）。
结论
本研究未发现证据表明长期使用DMPA、NET-EN和COC在基线或随访2.5年后会影响该人群的前臂BMD。本研究还报告了FSH和BMI对BMD影响的复杂关系和显著交互作用。对老年女性的BMD研究需要确保评估女性的绝经状态和BMI。
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