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Published in: Reproductive Health 1/2007

Open Access 01-12-2007 | Research

A three-year longitudinal evaluation of the forearm bone density of users of etonogestrel- and levonorgestrel-releasing contraceptive implants

Authors: Cecilia Monteiro-Dantas, Ximena Espejo-Arce, Jeffrey F Lui-Filho, Arlete M Fernandes, Ilza Monteiro, Luis Bahamondes

Published in: Reproductive Health | Issue 1/2007

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Abstract

Background

The aim of this study was to evaluate bone mineral density (BMD) at baseline and at 18 and 36 months of use of etonogestrel (ENG)-and levonorgestrel (LNG)-releasing contraceptive implants. This is a continuation of a previous study in which BMD was evaluated at baseline and at 18 months of use.

Methods

A total of 111 women, 19–43 years of age, wererandomly allocated to use one of the two implants. At 36 months of follow-up, only 36 and 39 women were still using the ENG- and LNG-releasing implants, respectively. BMD was evaluated at the distal and at the ultra-distal radius of the non-dominant forearm using dual-energy X-ray absorptiometry.

Results

There was no difference in the BMD of users of either implant at 18 and at 36 months. BMD was significantly lower at 18 and at 36 months at the distal radius in both groups of users compared to pre-insertion values; however, no difference was found at the ultra-distal radius.

Conclusion

Women 19–43 years of age using either one of these two contraceptive implants for 36 months had lower BMD values at the distal radius compared to pre-insertion values; however, no difference was found at the ultra-distal radius.
Literature
1.
go back to reference Curtis KM, Martins SL: Progestogen-only contraception and bone mineral density: a systematic review. Contraception. 2006, 73: 470-487. 10.1016/j.contraception.2005.12.010.CrossRefPubMed Curtis KM, Martins SL: Progestogen-only contraception and bone mineral density: a systematic review. Contraception. 2006, 73: 470-487. 10.1016/j.contraception.2005.12.010.CrossRefPubMed
3.
go back to reference Recker RR, Davies KM, Hinders SM, Heaney RP, Stegman MR, Kimmel DB: Bone gain in young adult women. JAMA. 1992, 268: 2403-2408. 10.1001/jama.268.17.2403.CrossRefPubMed Recker RR, Davies KM, Hinders SM, Heaney RP, Stegman MR, Kimmel DB: Bone gain in young adult women. JAMA. 1992, 268: 2403-2408. 10.1001/jama.268.17.2403.CrossRefPubMed
4.
go back to reference Gbolade B, Ellis S, Murby B, Randall S, Kirkman R: Bone density in long-term users of depot medroxyprogesterone acetate. Br J Obstet Gynaecol. 1998, 105: 790-794.CrossRefPubMed Gbolade B, Ellis S, Murby B, Randall S, Kirkman R: Bone density in long-term users of depot medroxyprogesterone acetate. Br J Obstet Gynaecol. 1998, 105: 790-794.CrossRefPubMed
5.
go back to reference Bahamondes L, Trevisan M, Andrade L, Marchi NM, Castro S, Faundes A: The effect upon the human vaginal histology of the long-term use of the injectable contraceptive Depo-Provera. Contraception. 2000, 62: 23-27. 10.1016/S0010-7824(00)00132-3.CrossRefPubMed Bahamondes L, Trevisan M, Andrade L, Marchi NM, Castro S, Faundes A: The effect upon the human vaginal histology of the long-term use of the injectable contraceptive Depo-Provera. Contraception. 2000, 62: 23-27. 10.1016/S0010-7824(00)00132-3.CrossRefPubMed
6.
go back to reference Cundy T, Evans M, Roberts H, Wattie D, Ames R, Reid IR: Bone density in women receiving depot medroxyprogesterone acetate for contraception. BMJ. 1991, 303: 13-16.CrossRefPubMedPubMedCentral Cundy T, Evans M, Roberts H, Wattie D, Ames R, Reid IR: Bone density in women receiving depot medroxyprogesterone acetate for contraception. BMJ. 1991, 303: 13-16.CrossRefPubMedPubMedCentral
7.
go back to reference Tang OS, Tang G, Yip P, Li B, Fan S: Long-term depot-medroxyprogesterone acetate and bone mineral density. Contraception. 1999, 59: 25-29. 10.1016/S0010-7824(98)00144-9.CrossRefPubMed Tang OS, Tang G, Yip P, Li B, Fan S: Long-term depot-medroxyprogesterone acetate and bone mineral density. Contraception. 1999, 59: 25-29. 10.1016/S0010-7824(98)00144-9.CrossRefPubMed
8.
go back to reference Petitti DB, Piaggio G, Mehta S, Cravioto MC, Meirik O: Steroid hormone contraception and bone mineral density: a cross-sectional study in an international population. The WHO Study of Hormonal Contraception and Bone Health. Obstet Gynecol. 2000, 95: 736-744. 10.1016/S0029-7844(00)00782-1.PubMed Petitti DB, Piaggio G, Mehta S, Cravioto MC, Meirik O: Steroid hormone contraception and bone mineral density: a cross-sectional study in an international population. The WHO Study of Hormonal Contraception and Bone Health. Obstet Gynecol. 2000, 95: 736-744. 10.1016/S0029-7844(00)00782-1.PubMed
9.
go back to reference United States Food and Drug Administration: Talk Paper Black Box Warning Added Concerning Long-Term Use of Depo-Provera Contraceptive Injection. November 17, 2004 United States Food and Drug Administration: Talk Paper Black Box Warning Added Concerning Long-Term Use of Depo-Provera Contraceptive Injection. November 17, 2004
11.
go back to reference D'Arcangues C: WHO statement on hormonal contraception and bone health. Contraception. 2006, 73: 443-444. 10.1016/j.contraception.2006.01.002.CrossRefPubMed D'Arcangues C: WHO statement on hormonal contraception and bone health. Contraception. 2006, 73: 443-444. 10.1016/j.contraception.2006.01.002.CrossRefPubMed
12.
go back to reference Taneepanichskul S, Intaraprasert S, Theppisai U, Chaturachinda K: Bone mineral density during long-term treatment with Norplant implants and depot medroxyprogesterone acetate. A cross-sectional study of Thai women. Contraception. 1997, 56: 153-155. 10.1016/S0010-7824(97)00116-9.CrossRefPubMed Taneepanichskul S, Intaraprasert S, Theppisai U, Chaturachinda K: Bone mineral density during long-term treatment with Norplant implants and depot medroxyprogesterone acetate. A cross-sectional study of Thai women. Contraception. 1997, 56: 153-155. 10.1016/S0010-7824(97)00116-9.CrossRefPubMed
13.
go back to reference Di X, Li Y, Zhang C, Jiang J, Gu S: Effects of levonorgestrel-releasing subdermal contraceptive implants on bone density and bone metabolism. Contraception. 1999, 60: 161-166. 10.1016/S0010-7824(99)00080-3.CrossRefPubMed Di X, Li Y, Zhang C, Jiang J, Gu S: Effects of levonorgestrel-releasing subdermal contraceptive implants on bone density and bone metabolism. Contraception. 1999, 60: 161-166. 10.1016/S0010-7824(99)00080-3.CrossRefPubMed
14.
go back to reference Beerthuizen R, van Beek A, Massai R, Makarainen L, Hout J, Bennink HC: Bone mineral density during long-term use of the progestagen contraceptive implant Implanon compared to a non-hormonal method of contraception. Hum Reprod. 2000, 15: 118-122. 10.1093/humrep/15.1.118.CrossRefPubMed Beerthuizen R, van Beek A, Massai R, Makarainen L, Hout J, Bennink HC: Bone mineral density during long-term use of the progestagen contraceptive implant Implanon compared to a non-hormonal method of contraception. Hum Reprod. 2000, 15: 118-122. 10.1093/humrep/15.1.118.CrossRefPubMed
15.
go back to reference Bahamondes L, Monteiro-Dantas C, Espejo-Arce X, Dos Santos Fernandes AM, Lui-Filho JF, Perrotti M, Petta CA: A prospective study of the forearm bone density of users of etonogestrel- and levonorgestrel-releasing contraceptive implants. Hum Reprod. 2006, 21: 466-470. 10.1093/humrep/dei358.CrossRefPubMed Bahamondes L, Monteiro-Dantas C, Espejo-Arce X, Dos Santos Fernandes AM, Lui-Filho JF, Perrotti M, Petta CA: A prospective study of the forearm bone density of users of etonogestrel- and levonorgestrel-releasing contraceptive implants. Hum Reprod. 2006, 21: 466-470. 10.1093/humrep/dei358.CrossRefPubMed
16.
go back to reference Pocock SJ: Clinical Trials: A Practical Approach. 1987, Chichester: John Wiley and Sons Pocock SJ: Clinical Trials: A Practical Approach. 1987, Chichester: John Wiley and Sons
17.
go back to reference Kanis JA, Johnell O, Oden A, Johansson H, De Laet C, Eisman JA, Fujiwara S, Kroger H, McCloskey EV, Mellstrom D, Melton LJ, Pols H, Reeve J, Silman A, Tenenhouse A: Smoking and fracture risk: a meta-analysis. Osteoporos Int. 2005, 16: 155-62. 10.1007/s00198-004-1640-3.CrossRefPubMed Kanis JA, Johnell O, Oden A, Johansson H, De Laet C, Eisman JA, Fujiwara S, Kroger H, McCloskey EV, Mellstrom D, Melton LJ, Pols H, Reeve J, Silman A, Tenenhouse A: Smoking and fracture risk: a meta-analysis. Osteoporos Int. 2005, 16: 155-62. 10.1007/s00198-004-1640-3.CrossRefPubMed
18.
go back to reference Kanis JA, Johansson H, Johnell O, Oden A, De Laet C, Eisman JA, Pols H, Tenenhouse A: Alcohol intake as a risk factor for fracture. Osteoporos Int. 2005, 16: 737-742. 10.1007/s00198-004-1734-y.CrossRefPubMed Kanis JA, Johansson H, Johnell O, Oden A, De Laet C, Eisman JA, Pols H, Tenenhouse A: Alcohol intake as a risk factor for fracture. Osteoporos Int. 2005, 16: 737-742. 10.1007/s00198-004-1734-y.CrossRefPubMed
19.
go back to reference Armitage P: Statistical Methods in Medical Research. 1991, New York: A Halsted Press Book, John Wiley and Sons Armitage P: Statistical Methods in Medical Research. 1991, New York: A Halsted Press Book, John Wiley and Sons
20.
go back to reference World Health Organization: Assessment of Fracture Risk and its Application to Screening for Post-menopausal Osteoporosis: Report of a WHO Study Group. WHO, Geneva (WHO technical report series 843). 1994 World Health Organization: Assessment of Fracture Risk and its Application to Screening for Post-menopausal Osteoporosis: Report of a WHO Study Group. WHO, Geneva (WHO technical report series 843). 1994
21.
go back to reference Croxatto HB, Urbancsek J, Massai R, Coelingh Bennink H, van Beek A: A multicentre efficacy and safety study of the single contraceptive implant Implanon. Implanon Study Group. Hum Reprod. 1999, 14: 976-981. 10.1093/humrep/14.4.976.CrossRefPubMed Croxatto HB, Urbancsek J, Massai R, Coelingh Bennink H, van Beek A: A multicentre efficacy and safety study of the single contraceptive implant Implanon. Implanon Study Group. Hum Reprod. 1999, 14: 976-981. 10.1093/humrep/14.4.976.CrossRefPubMed
22.
go back to reference Croxatto HB, Makarainen L: The pharmacodynamics and efficacy of Implanon. An overview of the data. Contraception. 1998, 58 (Suppl): 91-97. 10.1016/S0010-7824(98)00118-8.CrossRef Croxatto HB, Makarainen L: The pharmacodynamics and efficacy of Implanon. An overview of the data. Contraception. 1998, 58 (Suppl): 91-97. 10.1016/S0010-7824(98)00118-8.CrossRef
23.
go back to reference Croxatto HB, Diaz S, Pavez M, Brandeis A: Estradiol plasma levels during long-term treatment with Norplant subdermal implants. Contraception. 1988, 38: 465-475. 10.1016/0010-7824(88)90087-X.CrossRefPubMed Croxatto HB, Diaz S, Pavez M, Brandeis A: Estradiol plasma levels during long-term treatment with Norplant subdermal implants. Contraception. 1988, 38: 465-475. 10.1016/0010-7824(88)90087-X.CrossRefPubMed
24.
25.
go back to reference Diaz S, Reyes MV, Zepeda A, Gonzalez GB, Lopez JM, Campino C, Croxatto HB: Norplant implants and progesterone vaginal rings do not affect maternal bone turnover and density during lactation and after weaning. Hum Reprod. 1999, 14: 2499-2505. 10.1093/humrep/14.10.2499.CrossRefPubMed Diaz S, Reyes MV, Zepeda A, Gonzalez GB, Lopez JM, Campino C, Croxatto HB: Norplant implants and progesterone vaginal rings do not affect maternal bone turnover and density during lactation and after weaning. Hum Reprod. 1999, 14: 2499-2505. 10.1093/humrep/14.10.2499.CrossRefPubMed
26.
go back to reference Naessen T, Olsson SE, Gudmundson J: Differential effects on bone density of progestogen-only methods for contraception in premenopausal women. Contraception. 1995, 52: 35-39. 10.1016/0010-7824(95)00121-P.CrossRefPubMed Naessen T, Olsson SE, Gudmundson J: Differential effects on bone density of progestogen-only methods for contraception in premenopausal women. Contraception. 1995, 52: 35-39. 10.1016/0010-7824(95)00121-P.CrossRefPubMed
27.
go back to reference Cromer BA, Blair JM, Mahan JD, Zibners L, Naumovski Z: A prospective comparison of bone density in adolescent girls receiving depot medroxyprogesterone acetate (Depo Provera), levonorgestrel (Norplant), or oral contraceptives. J Pediatr. 1996, 129: 671-676. 10.1016/S0022-3476(96)70148-8.CrossRefPubMed Cromer BA, Blair JM, Mahan JD, Zibners L, Naumovski Z: A prospective comparison of bone density in adolescent girls receiving depot medroxyprogesterone acetate (Depo Provera), levonorgestrel (Norplant), or oral contraceptives. J Pediatr. 1996, 129: 671-676. 10.1016/S0022-3476(96)70148-8.CrossRefPubMed
28.
go back to reference Marshall D, Johnell O, Wedel H: Meta-analysis of how well measures of bone mineral density predict occurrence of osteoporotic fractures. BMJ. 1996, 312: 1254-1259.CrossRefPubMedPubMedCentral Marshall D, Johnell O, Wedel H: Meta-analysis of how well measures of bone mineral density predict occurrence of osteoporotic fractures. BMJ. 1996, 312: 1254-1259.CrossRefPubMedPubMedCentral
29.
go back to reference Siris ES, Miller PD, Barrett-Connor E, Faulkner KG, Wehren LE, Abbott TA, Berger ML, Santora AC, Sherwood LM: Identification and fracture outcomes of undiagnosed low bone mineral density in postmenopausal women: results from the National Osteoporosis Risk Assessment. JAMA. 2001, 286: 2815-2822. 10.1001/jama.286.22.2815.CrossRefPubMed Siris ES, Miller PD, Barrett-Connor E, Faulkner KG, Wehren LE, Abbott TA, Berger ML, Santora AC, Sherwood LM: Identification and fracture outcomes of undiagnosed low bone mineral density in postmenopausal women: results from the National Osteoporosis Risk Assessment. JAMA. 2001, 286: 2815-2822. 10.1001/jama.286.22.2815.CrossRefPubMed
30.
go back to reference Lopez LM, Grimes DA, Schulz KF, Curtis KM: Steroidal contraceptives: effect on bone fractures in women. Cochrane Database Syst Rev. 2006, CD006033-4 Lopez LM, Grimes DA, Schulz KF, Curtis KM: Steroidal contraceptives: effect on bone fractures in women. Cochrane Database Syst Rev. 2006, CD006033-4
31.
go back to reference Cummings SR, Bates D, Black DM: Clinical use of bone densitometry: scientific review. JAMA. 2002, 288: 1889-97. 10.1001/jama.288.15.1889.CrossRefPubMed Cummings SR, Bates D, Black DM: Clinical use of bone densitometry: scientific review. JAMA. 2002, 288: 1889-97. 10.1001/jama.288.15.1889.CrossRefPubMed
32.
go back to reference Orr-Walker BJ, Evans MC, Ames RW, Clearwater JM, Cundy T, Reid IR: The effect of past use of the injectable contraceptive depot medroxyprogesterone acetate on bone mineral density in normal post-menopausal women. Clin Endocrinol (Oxf). 1998, 49: 615-618. 10.1046/j.1365-2265.1998.00582.x.CrossRef Orr-Walker BJ, Evans MC, Ames RW, Clearwater JM, Cundy T, Reid IR: The effect of past use of the injectable contraceptive depot medroxyprogesterone acetate on bone mineral density in normal post-menopausal women. Clin Endocrinol (Oxf). 1998, 49: 615-618. 10.1046/j.1365-2265.1998.00582.x.CrossRef
33.
go back to reference Cefalu CA: Is bone mineral density predictive of fracture risk reduction?. Curr Med Res Opin. 2004, 20: 341-349. 10.1185/030079903125003062.CrossRefPubMed Cefalu CA: Is bone mineral density predictive of fracture risk reduction?. Curr Med Res Opin. 2004, 20: 341-349. 10.1185/030079903125003062.CrossRefPubMed
Metadata
Title
A three-year longitudinal evaluation of the forearm bone density of users of etonogestrel- and levonorgestrel-releasing contraceptive implants
Authors
Cecilia Monteiro-Dantas
Ximena Espejo-Arce
Jeffrey F Lui-Filho
Arlete M Fernandes
Ilza Monteiro
Luis Bahamondes
Publication date
01-12-2007
Publisher
BioMed Central
Published in
Reproductive Health / Issue 1/2007
Electronic ISSN: 1742-4755
DOI
https://doi.org/10.1186/1742-4755-4-11

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