Related Health Topics: MAQ Bulletin, Issue 1

Cross-Sectional Study of Bone Density in Long-Term Users of DMPA⁸

Abstract: In 1991 Cundy et al (New Zealand) reported that long-term DMPA users (more than 1 to 2 years) experienced a significant loss in bone density. The design of that study was flawed, however, and variance in the measurements was very high (in many cases, greater than the differences in the measured loss). Until this new (1995) paper was published there was no evidence to refute these findings. In the present cross-sectional study of long-term users of DMPA who were amenorrheic or only spotting for more than 1 year, spine and femoral neck bone density was measured and compared to that of an age-matched population of nonDMPA users. Based on the preliminary results, the authors found no significant changes in spinal or femoral neck bone density (measured as 98–99.5% of that of the age-matched population). Because the youngest subject was 21, however, this study does not shed any light on the question of possible bone loss in DMPA users who are very young—ages 13 to 16. (This is the time period when the rate of bone deposition is greatest, and the potential effect of changes in bone metabolism also could be the greatest.)

⁸ Gbolade BA and RJE Kirkman. University of Manchester: Manchester, England. (Abstract presented at the meeting of the Society for the Advancement of Contraception, Guatemala City, Guatemala, March 1995.)

Comparison Between Standard and “U” Techniques for Norplant Implants Removal⁹

Abstract: In this paper, Dr. Untung presented new data comparing the “U” technique with the standard removal method. These data indicated that with the “U” technique, the time for removal was less, fewer capsules were broken and there was less tissue trauma (i.e., fewer clients with postremoval hematoma: 2.44% versus 9.76%). A recently published JHPIEGO technical report concludes that the “U” technique appears to be more easily learned by inexperienced, novice removers than the standard technique for implants removal. In addition, the “U” technique appears to offer significant improvements in speed and safety over the standard technique recommended by the manufacturer without any significant increase in cost. This technical report recommends that large-scale training programs should consider using the “U” technique as the removal method of choice when training new providers in implants removal.¹⁰ (Investigators agree that correct insertion of the capsules is the single most important factor in making removal easy.)

⁹ Praptohardjo U. Department of Obstetrics and Gynecology, Medical Faculty Diponegoro University, Dr. Kariadi Hospital, Semarang, Indonesia. (Abstract presented at the meeting of the Society for the Advancement of Contraception, Guatemala City, Guatemala, March 1995.)

¹⁰ Blumenthal et al. 1996. Comparative Assessment of Norplant® Implants Removal Techniques: Indonesia. JHPIEGO Technical Report FCA-22. JHPIEGO: Baltimore, Maryland, USA.

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Cross-Sectional Study of Bone Density in Long-Term Users of DMPA8

Comparison Between Standard and “U” Techniques for Norplant Implants Removal9

Cross-Sectional Study of Bone Density in Long-Term Users of DMPA⁸

Comparison Between Standard and “U” Techniques for Norplant Implants Removal⁹