Division of Research, Kaiser Permanente Northern California, and the Departments of Obstetrics and Gynecology and Internal Medicine/Endocrinology, the Permanente Medical Group, Oakland, California.
Obstet Gynecol. 2019 Sep;134(3):581-589. doi: 10.1097/AOG.0000000000003414.
To assess fracture risk among women with depot medroxyprogesterone acetate (DMPA), oral contraceptive pill (OCP), and intrauterine device (IUD) use.
A retrospective cohort study of 308,876 women age 12-45 years who initiated DMPA, combined or progestin-only OCPs, and copper and levonorgestrel IUDs from 2005 to 2015. Cumulative DMPA, OCP, and IUD use was assessed. Time since last DMPA injection was quantified as recent (within 2 years) and past (more than 2 years ago). Crude fracture rate was estimated using a Poisson distribution. Unadjusted and adjusted hazard ratios (HRs) were estimated using cox proportional hazards models.
Thirteen percent of women used DMPA, 78.6% combined OCPs, 17.4% progestin-only OCPs, and 26.2% IUDs; 29.5% used more than one method. There were 7,659 fractures in 1,391,251 person-years (5.5/1,000 person-years [95% CI 5.4-5.6]). The fracture rate for women with any DMPA use was 6.6 (95% CI 6.1-7.2) and 7.8 (95% CI 6.0-10.0) for women with recent use and more than 2 years of cumulative use. Women who had recent use with 2 years or less, or more than 2 years of cumulative use had higher fracture risk compared with women who had no DMPA use and used other methods (adjusted HR 1.15 [95% CI 1.01-1.31] and 1.42 [95% CI 1.10-1.83], respectively). Fracture risk was not increased in women with past DMPA use. Women who had more than 2 years cumulative use of combined OCPs and women with any progestin-only OCP use had lower fracture risk compared with women who did not use OCPs and used other methods (adjusted HR 0.85 [95% CI 0.76-0.96] and 0.88 [95% CI 0.80-0.97], respectively).
Use of DMPA beyond 2 years should not be considered an absolute contraindication. Although DMPA use was associated with slightly increased fracture risk compared with other methods, the absolute risk of fracture was small and was not observed after discontinuation.
评估使用 depot 型醋酸甲羟孕酮（DMPA）、口服避孕药（OCP）和宫内节育器（IUD）的女性的骨折风险。
这是一项回顾性队列研究，纳入了 2005 年至 2015 年间年龄在 12-45 岁之间、开始使用 DMPA、复方或单纯孕激素 OCP 以及铜和左炔诺孕酮 IUD 的 308876 名女性。评估了累积 DMPA、OCP 和 IUD 的使用情况。最近（2 年内）和过去（2 年以上）使用最后一次 DMPA 注射的时间分别进行了量化。使用泊松分布估计骨折粗发生率。使用 cox 比例风险模型估计未经调整和调整后的风险比（HR）。
13%的女性使用了 DMPA，78.6%使用了复方 OCP，17.4%使用了单纯孕激素 OCP，26.2%使用了 IUD；29.5%的女性使用了多种方法。在 1391251 人年中，有 7659 例骨折（5.5/1000 人年[95%CI 5.4-5.6]）。有 DMPA 使用史的女性骨折发生率为 6.6（95%CI 6.1-7.2），最近使用且累积使用超过 2 年的女性骨折发生率为 7.8（95%CI 6.0-10.0）。与没有使用 DMPA 而使用其他方法的女性相比，最近使用 DMPA 且使用时间不足 2 年或超过 2 年的女性，骨折风险更高（调整 HR 1.15[95%CI 1.01-1.31]和 1.42[95%CI 1.10-1.83]）。过去使用 DMPA 的女性骨折风险没有增加。与未使用 OCP 而使用其他方法的女性相比，累积使用超过 2 年的复方 OCP 或使用任何单纯孕激素 OCP 的女性骨折风险较低（调整 HR 0.85[95%CI 0.76-0.96]和 0.88[95%CI 0.80-0.97]）。
DMPA 的使用超过 2 年不应被视为绝对禁忌证。尽管与其他方法相比，DMPA 与骨折风险略有增加有关，但骨折的绝对风险很小，并且在停止使用后并未观察到。
