Erhardt-Ohren Blake, Prata Ndola, Rosenblum Scott
Global Impact Advisors (Erhardt-Ohren and Prata), School of Public Health University of California Berkeley, Redwood City, CA.
Global Impact Advisors (Erhardt-Ohren, Prata and Rosenblum), Redwood City, CA.
AJOG Glob Rep. 2025 May 14;5(3):100509. doi: 10.1016/j.xagr.2025.100509. eCollection 2025 Aug.
The purpose of this paper is to consolidate existing evidence and identify knowledge and research gaps on the bone health effects of progestin-only oral contraception, injectables, hormonal intrauterine devices, and implants. implementation.
We searched PubMed, CINAHL, Web of Science, and The Cochrane Library for conference abstracts, original research articles, systematic reviews, and meta-analyses published between 05 May 2012 and 31 August 2023.
We limited results to any study design published as a conference abstract, original research study, meta-analysis, or systematic review in English-language peer-reviewed journals.
Two independent reviewers screened item titles. One reviewer read all abstracts and full papers, and a second reviewer confirmed alignment with a 5% sample of each. One reviewer extracted relevant information into Excel with a 5% sample review by another research team member. We reviewed the references for all included items and screened potentially relevant items in the same manner as described above. Subject matter experts contributed additional items. We assessed items using the Mixed Methods Appraisal tool.
The search strategy yielded 32 items, most of which explored the use of intra-muscular depot medroxyprogesterone acetate 150mg. We found a clear association between any use of depot medroxyprogesterone acetate and bone mineral density loss. This negative effect seems to be more common among younger women and women on antiretrovirals. There is, however, evidence to suggest that bone loss can be restored after depot medroxyprogesterone acetate discontinuation. Hormonal intrauterine device and implant users do not seem to experience bone mineral density loss.
While there is a clear association between bone mineral density loss and depot medroxyprogesterone acetate injectable use, treatment during contraceptive use and bone health restoration following discontinuation are not adequately researched. In this review, we provide evidence that bone health can be partially or completely restored after depot medroxyprogesterone acetate discontinuation, identify opportunities to learn more about depot medroxyprogesterone acetate injectables and bone health during and after use, and find gaps in knowledge on potential associations between bone health and other progestin-only contraceptives.
本文旨在整合现有证据，确定仅含孕激素的口服避孕药、注射剂、激素宫内节育器和植入剂对骨骼健康影响方面的知识和研究空白。
我们在PubMed、CINAHL、科学网和考克兰图书馆中检索了2012年5月5日至2023年8月31日期间发表的会议摘要、原创研究文章、系统评价和荟萃分析。
我们将结果限制为在英文同行评审期刊上发表的会议摘要、原创研究、荟萃分析或系统评价等任何研究设计。
两名独立评审员筛选文章标题。一名评审员阅读所有摘要和全文，另一名评审员对其中5%的样本进行确认核对。一名评审员将相关信息提取到Excel中，另一名研究团队成员对5%的样本进行复核。我们查阅了所有纳入文献的参考文献，并以与上述相同的方式筛选潜在相关文献。主题专家补充了其他文献。我们使用混合方法评估工具对文献进行评估。
检索策略共产生32篇文献，其中大部分探讨了150mg醋酸甲羟孕酮长效注射剂的使用情况。我们发现使用任何醋酸甲羟孕酮长效注射剂与骨密度降低之间存在明显关联。这种负面影响在年轻女性和服用抗逆转录病毒药物的女性中似乎更为常见。然而，有证据表明在停用醋酸甲羟孕酮长效注射剂后骨量流失可以恢复。激素宫内节育器和植入剂使用者似乎没有骨密度降低的情况。
虽然骨密度降低与醋酸甲羟孕酮长效注射剂的使用之间存在明显关联，但关于避孕期间的治疗以及停用后的骨骼健康恢复情况尚未得到充分研究。在本综述中，我们提供了证据表明停用醋酸甲羟孕酮长效注射剂后骨骼健康可以部分或完全恢复，确定了更多了解醋酸甲羟孕酮长效注射剂在使用期间及之后与骨骼健康关系的机会，并发现了骨骼健康与其他仅含孕激素避孕药潜在关联方面的知识空白。
