“Bad to the Bone”

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Based on the United Nations’ 1998 predictions, over seven percent of the Malaysian population will be over the age of sixty-five by 2020 and the rate of hip fractures will increase from seventy-three to ninety per 100,00 individuals more than fifty years of age over the decade. Why is this so? What is a contributing factor to these numbers? One major factor involves the use of injectable birth control (Mohammadi , Aizan, Nazri , Othman, Mahmud 1187-1194). Malaysian women most commonly use injectable birth controls such as Net-in or Unidepo. Osteoporosis, a form of chronic metabolic disease, is a prevalent and serious health problem worldwide. It leads to significant morbidity and mortality due to subsequent fractures and finally a deteriorated quality of life. This will present a problem for developed and underdeveloped countries as a result of the volume of the elderly population (Mohammadi , Aizan, Nazri , Othman, Mahmud 1187-1194).

The study that was done consisted of a total of 201 healthy postmenopausal women, including 133 women with and 68 without Unidepo usage history, were enrolled through purposive sampling method from menopause clinics. Subjects who had menopausal hormone therapy throughout the previous six months or longer, took Vitamin D or calcium supplements for more than one month during the previous year, or took medicines affecting bone density and diseases influencing bone health were all excluded. All subjects were interviewed for baseline characteristics and Unidepo injection history. A validated food frequency questionnaire for Malaysia was used to determine the calcium intake and body mass index (BMI) was calculated. Evaluation of bone status was performed using calcaneal Quantitative Ultrasound. All participants were required to provide a measure of their daily activity (Mohammadi, Aizan, Nazri, Othman, Mahmud 1187-1194).

Results showed that the mean of age, age at menopause, years after menopause, per capita income, BMI, and calcium intake in non-users were higher than users of Unidepo. The results also revealed that postmenopausal women who use Unidepo for more than seven years had the highest percentage of bone density/bone loss. Another important finding was that Malay women over forty who used the injectable birth control for longer periods of time resulted in the manifestation of bone loss (Mohammadi , Aizan, Nazri , Othman, Mahmud 1187-1194).

Limitations in the study that may have caused some discrepancies include some of the users in the study used Unidepo for as long as nineteen years. Using the drug for a long period of time may result in irreversibility of bone mass. Other limitations include differences in study design, variation in the number and age of enrolled subjects, the bone sites used in measurement, statistical tests, and the follow-up period. Researchers were not able to use the DXA x-ray, which is the gold standard for bone measurement, because of its non-affordability. Another limitation is that the site where bone density was measured was the calcaneus. However, the most susceptible places in the body for bone loss are the hip and spine. Because bone density was not measured here, results were not generalized to the whole skeleton (Mohammadi , Aizan, Nazri , Othman, Mahmud 1187-1194).

A strength of the study is researchers assessing the effect of injectables on bone mass density in post-menopausal women. There are very few studies that have assessed these effects in post-menopausal women. Incorporating long-term users of Unidepo is also a strength of the research. Although there may be other risk factors involved in the development of bone density, it can be concluded from the study that postmenopausal former Unidepo users who used the drug after age 40 and for longer periods of time are more susceptible to develop osteoporosis (Mohammadi , Aizan, Nazri , Othman, Mahmud 1187-1194).

Works Cited

Fatemeh Mohammadi  , Hamid Tengku Aizan  , Mohd Yazid Nazri  , Zanariah Othman , Mahmud , . "The effect of past use of injectable contraceptive on bone mineral density in malaysian postmenopausal women." HealthMED. 5.5 (2011): 1187-1194. Print. <http://ehis.ebscohost.com/ehost/pdfviewer/pdfviewer?sid=b2ece5d5-5b58-4fc0-a550-a063c9f6dbe0@sessionmgr113&vid=4&hid=109>.