August 13th 2010 Journal Club Presentation
Abigail Donaldson
For this Journal Club presentation there will be a comparison between two studies on bone mineral density and
contraception. The analysis of each article will take about 20 minutes, and then we will have a few minutes at the end
for comparison of the findings and discussion in the context of a clinical case.
Journal Club Articles:
1. Harel Z, Cole Johnson C, Gold MA, et al. Recovery of bone mineral density in adolescents following the use of
depot medroxyprogesterone acetate contraceptive injections. Contraception 2010; 81: 281-291.
2. Scholes D, Ichikawa L, LaCroix AZ, et al. Oral contraceptive use and bone density in adolescent and young adult
women. Contraception 2010; 81: 35-40.
Supportive Articles (Recommended, but will not specifically be discussed):
1. Johnson CC, Burkman RT, Gold MA, et al. Longitudinal study of depot medroxyprogesterone acetate (Depo
Provera) effects on bone health in adolescents: study design, population characteristics and baseline bone
mineral density. Contraception 2008; 77: 239-48.
2. Grimes DA, Schultz KF. Bias and causal associations in observational research. Lancet 2002; 359: 248-252.
3. Grimes DA, Schultz KF. Descriptive studies: what they can and cannot do. Lancet 2002; 359: 145-149.
Part One: Analysis of Article #1 (Harel et al.)
Introduction:
1. What is the purpose of this prospective non-randomized observational study?
2. Do the authors convince you of the importance of their study? How does this project hope to contribute to the
field?
Methods:
1. What are the primary outcomes of the study?
2. What are the advantages/disadvantages of heaving each patient act as their own “control” over time?
3. What factors other than BMD and Depo duration were included in the covariate vs. stratified analyses? Are
there others that might have been included that were not?
Results:
1. Why might the teens in this study have higher Z-scores at baseline than the age-specific reference population?
Does this make interpretation of the data more difficult?
2. Of the factors included in the analysis (those mentioned in question 3 in the Methods section, above) which
ones had a significant impact on BMD change?
3. Did the study participants recover their baseline BMD after discontinuation of Depo Provera? Did they maintain
it over time?
Discussion:
1. Does this study apply to our patient population?
2. What were the limitations of the study?
Part Three: Analysis of Article #2 (Scholes et al.)
Introduction:
1. What is the purpose of this population-based cross-sectional evaluation?
2. Do the authors convince you of the importance of their study?
Methods:
1. How were the study participants selected, and what were the components of the study that each participant
had to complete?
2. Are there components of the methodology that would predispose the study population to bias?
Results:
1. Were there differences in BMD between adolescents (14-18 year olds) and young adults (19-30 year olds)?
2. Were there differences in BMD between participants taking 30-35 mcg ethinyl estradiol OCP’s compared to
those taking OCP’s with <30 mcg of ethinyl estradiol?
Discussion:
1. Why might the adolescent group have less evidence of BMD change compared to the young adult group? How
might this impact your clinical consideration of OCP use?
2. How might OCP’s impact bone development in adolescent and young adult women?
Part Four: Comparison in the context of clinical care
1.
After reading these two studies, will your counseling change in terms of selecting hormonal contraception
methods and bone mineral density?
2. By switching our patient (presented at the beginning) from Depo Provera to OCP’s, is it fair to tell her that her
risk of low bone mineral density over time is improved on the latter medication?
3. What else should we be doing to maximize bone mineral density among our patients?
Calcium and Vitamin D, weight bearing exercise, no smoking
References:
1. House OD, Worrall A. Research by trainees; a strategy to improve standards of education and supervision.
Psychiatric Bulletin 1995; 19: 337-340.
2. Pope C, Mays N. Qualitative Research in Healthcare, 2nd Edition. London: British Medical Journal Books; 1999.
3. Colton T. Statistics in Medicine. Boston: Little, Brown; 1974.