Depot medroxyprogesterone acetate, oral contraceptives and bone mineral density in a cohort of adolescent girls.
OBJECTIVE
To conduct a longitudinal comparison of bone mineral density (BMD) in 370 adolescent girls, aged 12-18, who self-selected depot medroxyprogesterone acetate (DMPA) or an oral contraceptive (OC) containing 20 microg ethinyl estradiol/100 microg levonorgestrel with that in girls who received no hormonal treatment (control group).


METHODS
Lumbar spine and femoral neck BMD measurements were obtained by dual energy x-ray absorptiometry at baseline and 12 months. Data were analyzed with repeated measures analysis of covariance methods.


RESULTS
Over 12 months, lumbar spine BMD decreased in the DMPA group (n = 29), with a mean percent change of -1.4% (95% confidence interval [CI] -2.73, -0.10), and increased by a mean of 3.8% (95% CI 3.11, 4.57) in the control group [n = 107 (p < .001)]. The increase in mean percent change in lumbar spine BMD in the OC group (n = 79), 2.3% (95% CI 1.49, 3.18), was significantly smaller than in the control group (p = .03). Over 12 months, the mean percent change in femoral neck BMD was -2.2% (95% CI -3.95, -0.39) in the DMPA group, but increased 2.3% (95% CI 1.29, 3.27) in the control group (p < .001). The increase in mean percent change at the femoral neck in the OC group, 0.3% (95% CI -0.87, 1.41), was significantly lower than in the control group (p = .03).


CONCLUSIONS
Our study contributes to an increasing body of knowledge indicating a negative impact of DMPA on bone health in young women. Additional findings suggest a potential adverse effect of an OC containing 20 microg ethinyl estradiol/100 microg levonorgestrel on bone health in adolescents.
Cromer
Barbara A
BA
Department of Pediatrics, MetroHealth Medical Center, Cleveland, OH 44109, USA. bcromer@metrohealth.org
Stager
Margaret
M
Bonny
Andrea
A
Lazebnik
Rina
R
Rome
Ellen
E
Ziegler
Julie
J
Debanne
Sara M
SM
D015502:Absorptiometry, Photon; D000293:Adolescent; D016497:Adolescent Health Services / Q000592:standards; D015992:Body Mass Index; D018488:Bone Demineralization, Pathologic / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000517:prevention & control; D015519:Bone Density / Q000187:drug effects*; D001846:Bone Development / Q000187:drug effects; D015331:Cohort Studies; D016001:Confidence Intervals; D003271:Contraceptive Agents, Female / Q000008:administration & dosage / Q000009:adverse effects*; D003278:Contraceptives, Oral, Hormonal / Q000009:adverse effects; D003280:Contraceptives, Oral, Synthetic / Q000009:adverse effects; D003692:Delayed-Action Preparations / Q000009:adverse effects; D004997:Ethinyl Estradiol / Q000008:administration & dosage / Q000009:adverse effects*; D005260:Female; D005272:Femur Neck / Q000378:metabolism; D006266:Health Education; D006801:Humans; D016912:Levonorgestrel / Q000008:administration & dosage / Q000009:adverse effects*; D008159:Lumbar Vertebrae / Q000378:metabolism; D017258:Medroxyprogesterone Acetate / Q000008:administration & dosage / Q000009:adverse effects*; D016017:Odds Ratio; D011446:Prospective Studies; D012307:Risk Factors; D013997:Time Factors; D014481:United States / Q000453:epidemiology
D003271:Contraceptive Agents, Female; D003278:Contraceptives, Oral, Hormonal; D003280:Contraceptives, Oral, Synthetic; D003692:Delayed-Action Preparations; D004997:Ethinyl Estradiol; D016912:Levonorgestrel; D017258:Medroxyprogesterone Acetate