Perbedaan kadar collagen cross-linked C-Telopeptides (CTx) tulang pada wanita postmenopause riwayat penggunaan kontrasepsi Hormonal Depo Provera® (injeksi depot medroksi progesteron asetat) dengan kontrasepsi Non Hormonal

Oleh :
Agus Joko Santoso - - Fak. Kedokteran

Abstrak Latar Belakang. Insidensi osteoporosis semakin hari semakin bertambah, terutama pada usia lanjut atau postmenopause. Defisiensi estrogen berpengaruh terhadap proses bone remodeling. Kontrasepsi hormonal Depo Provera® (injeksi depot medroksiprogesteron asetat/DMPA) pada usia reproduktif cukup efektif mencegah ovulasi, tetapi juga memberikan efek kehilangan densitas tulang dengan tingkat resorpsi tulang lebih tinggi daripada formasi tulang. Progesteron mempunyai efek antagonis terhadap estrogen. Salah satu biomarker bone turnover resorpsi tulang mutakhir adalah Collagen cross-linked C-Telopeptides (CTx). Tujuan penelitian. Membuktikan perbedaan kadar CTx pada wanita postmenopause riwayat penggunaan kontrasepsi hormonal Depo Provera® dengan kontrasepsi non hormonal di Rumah Sakit Umum Daerah Dr.Moewardi Surakarta dan membuktikan hubungan antara lama mengikuti dan lama berhenti KB kontrasepsi hormonal Depo Provera® tersebut terhadap kadar CTx. Metodologi. Jenis penelitian ini analitik observational dengan pendekatan cross sectional. Penelitian dilakukan di poliklinik Penyakit Dalam RSUD dr. Moewardi Surakarta, mulai bulan April-Juni 2009. Populasi wanita postmenopause sesuai kriteria inklusi dan eksklusi dibagi dua, kelompok satu riwayat kontrasepsi hormonal Depo Provera® dan kelompok dua kontrasepsi non hormonal. Seluruh subyek diukur kadar CTx serumnya. Uji hipotesis dengan menggunakan uji t dan uji Mann Whitney. Hasil. Didapatkan 24 subyek penelitian, 14 subyek riwayat kontrasepsi hormonal Depo Provera ®, 10 subyek riwayat kontrasepsi non hormonal. Tidak didapatkan perbedaan yang signifikan kadar CTx tulang pada wanita postmenopause riwayat penggunaan kontrasepsi hormonal Depo Provera® dengan kontrasepsi non hormonal (p>0,05) dan positif signifikan antara lama mengikuti KB DMPA (p=0,010) dengan kadar CTx, negatif signifikan antara lama berhenti KB DMPA dengan kadar CTx (p=0,027) nilai r korelasi -0,527. Kesimpulan. Tidak didapatkan perbedaan yang signifikan antara kadar CTx tulang pada wanita postmenopause riwayat penggunaan kontrasepsi hormonal Depo Provera® dengan kontrasepsi non hormonal dan hasil positif signifikan antara lama mengikuti KB Depo Provera® dengan kadar CTx dan hasil negatif signifikan antara lama berhenti KB Depo Provera® dengan kadar CTx. Abstract Background. Incidence of osteoporosis is increased, especially in older or post-menopausal woman. Estrogen deficiency is correlated with bone remodeling process. Hormonal contraception Depo Provera® (depot medroxyprogesterone acetate injection/DMPA injection) in reproductive age is effective to prevent ovulation, but also has effect on loss of bone density in which bone resorption is higher than bone formation. Progesterone has antagonist effect on estrogen. New biomarkers of bone resorption are Collagen cross-linked C-Telopeptides (CTx). Aim. To prove the difference of CTx level in postmenopausal woman with history of using hormonal contraception Depo Provera® and non-hormonal contraception in Dr.Moewardi Hospital, Surakarta and prove the association between period of using and period of stopping hormonal contraception Depo Provera® on CTx level. Methods. This was an observational analysis study with cross sectional approach. The study is carried out at internal medicine polyclinic in Dr.Moewardi hospital, Surakarta, from April to June 2009. Population of menopause women based on inclusion and exclusion criteria were separated into two groups, first group was population with history of using hormonal contraception Depo Provera® and the second group was population with history of using non-hormonal contraception. All of the subjects were measured for the CTx serum level. The hypothesis was analyzed with t test and Mann Whitney test. Result. We found 24 study subjects consist of 14 subjects with history of using hormonal contraception Depo Provera® and 10 subjects with history of using non-hormonal contraception. In our analysis, there was no statistically significance difference in bone CTx level in postmenopausal woman with history of using hormonal contraception Depo Provera® and non-hormonal contraception (p>0.05) and there was positive significance difference in period of using hormonal contraception Depo Provera® and CTx level (p=0.010) and there was negative significance difference in period of stopping hormonal contraception Depo Provera® and CTx level (p=0,027) with correlation r ratio -0,527. Conclusion. There is no significance difference between bone CTx level in post-menopausal woman with history of using hormonal contraception Depo Provera® and non-hormonal contraception and there is positive significance difference in period of using hormonal contraception Depo Provera® and CTx level.