Institute of Gerontology Bone loss in Postmenopausal former Unidepo users Fatemeh Mohammadi Prof.Tengku Aizan Hamid Prof.Mohd Nazri Yazid Dr. Zanariah Othman Prof. Rozi Mahmud
Introduction One of the most successful, convenient, long acting, reversible means of contraception are Injectables More than 30 million are using three types of Injectables with annual pregnancy rate less than 1% DMPA and NET-EN EN are progesterone only injectables while the Cyclofem contains a mix of estrogen and Progestin. The type of injectables using in Malaysia, is Unidepo Problem statement For a number of years the potential effect of injectables on bone density has been a concern
Osteoporosis is a major public health problem because of its profound medical and socioeconomic effects Most common risk factors for developing osteoporosis: AGE GENDER RACE HEIGHT AND WEIGHT SEDENTARY LIFE STYLE INADEQUATE PHYSICAL ACTIVITY ALCOHOL AND CAFFEIN CONSUMPTION CIGARETTE SMOKING EDUCATION FAMILY HISTORY OF OSTEOPOROSIS PERSONAL OR FAMILY HISTORY OF FRACTURE SOME MENSTRUAL AND OBSTETRICAL FACTORS CERTAIN MEDICATION SOME MEDICAL CONDITIONS LOW CASLCIUM AND VITAMIN D INTAKE Injectables Problem statement (cont..) The incidence of osteoporosis is expected to increase in view of the rapidly ageing population of Malaysia. Women especially in postmenopausal are at particular risk for osteoporosis and fracture Osteoporotic fractures are to become a major health burden in Malaysia as in just over a decade, hip fracture rates increased from 73 to 90 per 100,000 persons over 50 (Chee, 2003.,Lau etal, 2001).
7 Problem statement (cont..) Consequences of fracture: Considerable pain Decreased quality of life Lost workdays Disability lose their social independence pulmonary embolism Death Medical cost (Estimated the medical cost for hip fracture at RM22 million in Malaysia in 2001) (Renee et al., 2004; Gambert et al.,1995; Keramat,2008; Lim et al., 2005;Irish Osteoporosis society; Gambert et al., 1995;BMJ, 1994; Nieves, 2008; Levie, 2000; www.mamashealth.com; Lyndhurst, 2008; WHO,2007; Suzannae,2005)
Significance of study No enough data on the risk factors of osteoporosis in developing countries and no data on impact of Unidepo on bone mineral density in Malaysia A controversial relationship between the osteoporosis and many risk factors especially hormonal contraceptives Morbidity and mortality due to osteoporosis is very high Many postmenopausal women at risk of osteoporosis remain undiagnosed and untreated and bone density is the best predictor of fracture risk (Walsh, 2008; Jevlosec, 2005; Renee, 2004; Baheiraei, 2005; Arcanques, 2005) Significance of study (cont..) Very limited studies have been done on NET-EN Limiting the use of injectables may be critical for women from Southeast Asia and Sub-Saharan Africa. Injectables have many advantages compared other contraceptives so it could not be set aside easily (Bahamondes, 2006., Keramat, 2008; www.scielo.org ; Lau et al.,2001; USAID/W,2000)
objective The goal of this paper was to investigate the effect of Unidepo usage after 40 years old, on Bone Mass in postmenopausal Malaysian women.
Methodology Design: Quasi-experimental Location: Menopause clinics of HKL and LPPKN Population: Postmenopausal former Unidepo users Exclusion criteria: Women on HRT, Calcium or vitamin D, bone drug and medications affecting the bone mass Methodology(cont.) Data collection: Questionnaire SECA VAS FFQ QUS
RESULTS
Result of bone measurement in relation to Unidepo age groups Age group BUA T-Score Z-Score Never user 45.20-1.03 0.004 <25 41.40-1.34-0.48 25-40 42.00-1.13-0.15 >40 35.46-1.64-0.88 Total 41.35-1.26-0.30 Result Significant association between Unidepo usage after age 40and BUA, after controlling: Age BMI HRT Calcium Education Osteoporosis history Years since menopause Years after discontinuation
Result of regression analysis to predict BUA B SE Beta (Constant) 23.228 21.124 Age of Unidepo Use -6.539 1.940 -.219*** Age -0.566.342 -.108 Education 1.858 1.237.113 Osteoporosis history -7.181 2.193 -.228** BMI 1.634.339.339*** Calcium intake 0.021.006.255** Years from menopause 1.389 1.822.047 Years after cessation 2.020 2.058.063 HRT 0.210 2.285.006 β= 0.22, p 0.001 ** p<.01 *** p<.001 R = 0.752, R 2 = 0566, Adj. R 2 = 0.534; F= 17.837, P = 0.0001
CONCLUSION Bone loss in postmenopausal women with Unidepo usage after 40 is more than other age groups BMD is not completely reversible after 40
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