Associations between fracture incidence and use of depot medroxyprogesterone acetate and anti-epileptic drugs in women with developmental disabilities

Watson, Kathleen C.; Lentz, Martha J.; Cain, Kevin C.

doi:10.1016/j.whi.2006.09.003

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Volume 16, Issue 6 , Pages 346-352, November 2006

Associations between fracture incidence and use of depot medroxyprogesterone acetate and anti-epileptic drugs in women with developmental disabilities

Kathleen C. Watson, RN, PhD
- Biobehavioral Nursing and Health Systems, School of Nursing, Seattle, Washington
- Center on Human Development and Disability, University of Washington, Seattle, Washington
- Correspondence to: Kathleen C. Watson, RN, PhD, Department of Biobehavioral Nursing and Health Systems, Center on Human Development and Disability, University of Washington, Box 357266, Seattle, WA 98195-7266.
Martha J. Lentz, RN, PhD
- Biobehavioral Nursing and Health Systems, School of Nursing, Seattle, Washington
- Office for Nursing Research, School of Nursing, University of Washington, Seattle, Washington
Kevin C. Cain, PhD
- Office for Nursing Research, School of Nursing, University of Washington, Seattle, Washington
- Department of Biostatistics, School of Public Health and Community Medicine, University of Washington, Seattle, Washington

Received 20 October 2005; received in revised form 26 September 2006; accepted 26 September 2006.

Purpose

We sought to evaluate any association between incidence of osteoporotic fractures and use of depot medroxyprogesterone acetate (DMPA) and/or anti-epileptic drugs (AEDs) among women and girls with developmental disabilities.

Methods

Cross-sectional population-based observational study of all noninstitutionalized females with developmental disabilities age ≥13 who received fee-for-service Medicaid in Washington State during 2002 (n = 6,773), using administrative data.

Main Findings

In a sample of 6,773 females, 140 women (2%) had an osteoporotic fracture during 2002. Among 340 users of DMPA, 13 (3.8%) had an osteoporotic fracture with an odds ratio of 2.4 (95% confidence interval [CI], 1.3–4.4) for fracture compared to nonusers. Among 1,909 users of AEDs, 60 (3.1%) had an osteoporotic fracture with an odds ratio of 1.9 (95% CI, 1.3–2.6) for fracture compared to nonusers. We controlled for use of drugs (DMPA or AEDs), age and race (as white or other racial and ethnic groups).

Conclusions

Use of either AEDs or DMPA by women with developmental disabilities is associated with significantly increased incidence of fracture. Women and girls who have developmental disabilities may be poor candidates for DMPA use owing to increased risk of fractures. Further research is indicated to 1) determine the specific risks profile of DMPA for this population, 2) explore alternative means of managing significant menstrual problems and contraceptive needs in this population, and 3) screen current and previous users of DMPA and chronic users of AEDs for osteoporosis risk, regardless of age.