肌注醋酸甲羟孕酮对25～40岁妇女骨矿物质密度的影响及停药后的恢复

目的:观察应用醋酸甲羟基孕酮(DMPA)避孕对BMD的影响,分析停药后的恢复情况。方法:随机选择68例应用DMPA避孕的25～40岁女性,每3个月肌注DMPA 1次,用药24个月;同时选择59例25～40岁未应用激素避孕药的女性作为对照,其中用药组61例,对照组52例完成2年的停药观察。对两组患者用药及随访期间应用双能X光线吸收法测量腰椎和股骨颈BMD。结果:用药组用药2年后腰椎和股骨颈平均BMD从基础值(1.11±0.11)g/cm2和(0.91±0.10)g/cm2下降到(1.05±0.10)g/cm2和(0.86±0.10)g/cm2,分别下降了5.52%和6.35%;与对照组相比骨矿物质密度明显降低(P<0.001)。停药2年后,应用DMPA组平均BMD明显增高,虽然DMPA组腰椎和股骨颈BMD仍然低于其用药前基础水平的1.08%和2.30%,但与对照组相比,无统计学差异(P>0.05)。结论:年龄25～40岁女性应用DMPA导致骨矿物质密度降低,停止注射DMPA后,因使用DMPA所致BMD降低得以恢复。

Effect of intramuscular injection of medroxyprogesterone acetate on bone mineral density of 25-40-year-old women and the recovery after drug withdrawal

Objective:To observe the effect of contraception with medroxyprogesterone acetate(DMPA) on bone mineral density(BMD),analyze the recovery after drug withdrawal.Methods:Sixty-eight 25-40-year-old women who used DMPA for contraception were selected randomly,then they were treated with intramuscular injection of DMPA every three months for 24 months;fifty-nine 25-40-year-old women who didn’t use hormonal contraceptive products during the same period were selected as control group;61 women in DMPA group and 52 women in control group completed the observation after drug withdrawal for two years.Dual energy X-ray absorptiometry was used to measure BMD values of lumbar vertebra and neck of femur in the two groups during medication period and follow-up period.Results:In DMPA group,the mean BMD values of lumbar vertebra and neck of femur decreased from(1.11±0.11) g/cm2 and(0.91±0.10) g/cm2 to(1.05±0.10) g/cm2 and(0.86±0.10) g/cm2,respectively,falling by 5.52% and 6.35%,respectively;compared with control group,BMD values decreased significantly(P<0.001).At two years after drug withdrawal,the mean BMD value in DMPA group increased significantly,BMD values of lumbar vertebra and neck of femur in DMPA group were still lower than the basic levels before treatment by 1.08% and 2.30%,respectively,but compared with control group,there was no significant difference(P>0.05).Conclusion:DMPA can induce the decrease of BMD among 25-40-year-old women,but the effect can be relieved after DMPA discontinuation.