Bone mineral density in midlife long-term users of hormonal contraception in South Africa: relationship with obesity and menopausal status

dc.contributor.authorBeksinska, Mags E.
dc.contributor.authorSmit, Jenni A.
dc.contributor.authorKleinschmidt, Immo
dc.date.accessioned2024-10-25T10:17:34Z
dc.date.available2024-10-25T10:17:34Z
dc.date.issued2018-04
dc.description.abstractBackground: 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 (p = 0.26) with and without adjustment for age at baseline or at 2.5 years (p = 0.52). The BMD was found to be significantly associated with BMI (p = < 0.0001) with an increase of one unit of BMI translating to an increase of 0.0044 g/cm2 in radius BMD. Follicle stimulating hormone (FSH) level ≥ 25.8 mIU/mL was associated with a decrease of 0.017 g/cm2 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 (p = .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.
dc.description.sponsorshipWorld Health Organization.
dc.description.submitterPM2024
dc.facultyFaculty of Health Sciences
dc.identifier0000-0002-4169-4112
dc.identifier.citationBeksinska, M.E., Kleinschmidt, I. & Smit, J.A. Bone mineral density in midlife long-term users of hormonal contraception in South Africa: relationship with obesity and menopausal status. womens midlife health 4, 6 (2018). https://doi.org/10.1186/s40695-018-0035-0
dc.identifier.issn2054-2690 (online)
dc.identifier.other10.1186/s40695-018-0035-0
dc.identifier.urihttps://hdl.handle.net/10539/41962
dc.journal.titleWomen's Midlife Health
dc.language.isoen
dc.publisherBMC
dc.relation.ispartofseriesVol. 4; No.6
dc.rights© The Author(s). 2018 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License.
dc.schoolSchool of Clinical Medicine
dc.subjectDepot-medroxyprogesterone acetate
dc.subjectNorethisterone enanthate
dc.subjectCombined oral contraceptives
dc.subjectBone mineral density
dc.subjectMenopause
dc.subjectFollicle stimulating hormone
dc.subjectBody mass index
dc.subject.otherSDG-3: Good health and well-being
dc.titleBone mineral density in midlife long-term users of hormonal contraception in South Africa: relationship with obesity and menopausal status
dc.typeArticle
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