Bone mineral density loss and recovery during 48 months in first-time users of depot medroxyprogesterone acetate.
OBJECTIVE
To compare changes in bone mineral density (BMD) during 48 months between first-time depot medroxyprogesterone acetate (MPA) users, during use and after discontinuation, to controls.


METHODS
Longitudinal study.


METHODS
Academic community.


METHODS
Women 18-35 years, newly initiating depot MPA (n = 178) and controls (n = 145) not using hormonal contraception.


METHODS
The BMD of the hip and spine, measured at 3-month intervals, by dual energy roentgen absorptiometry.


RESULTS
Hip and spine BMD declined during 48 months of depot MPA use by 7.7% +/- 0.11% (mean +/- SE) and 6.4% +/- 0.36%, respectively. The BMD of controls declined <or=1.6% +/- 0.30%. Hip and spine BMD loss slowed to <0.6% after 48 months of depot MPA use. After discontinuation, BMD increased from 0.3% to 2.0% per year depending on length of depot MPA use and bone site. The longest depot MPA users remained 4.7% and 2.9% lower than hip and spine baseline values, respectively, 18 months after discontinuation.


CONCLUSIONS
Depot MPA-related BMD loss is substantial but occurs mostly during the first 2 years of DMPA use. Therefore, longer use may not substantially increase the risk of osteoporosis. The prolonged recovery time suggests the need to consider timing of use in relation to menopause or other factors that may impede bone remodeling.
Clark
M Kathleen
MK
College of Nursing, University of Iowa, Iowa City, Iowa 52241, USA. mary-clark@uiowa.edu
Sowers
Maryfran
M
Levy
Barcey
B
Nichols
Sara
S
D015519:Bone Density / Q000187:drug effects*; D001846:Bone Development / Q000187:drug effects*; D003271:Contraceptive Agents, Female / Q000008:administration & dosage; D003692:Delayed-Action Preparations / Q000008:administration & dosage; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D017258:Medroxyprogesterone Acetate / Q000008:administration & dosage*; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D016896:Treatment Outcome
D003271:Contraceptive Agents, Female; D003692:Delayed-Action Preparations; D017258:Medroxyprogesterone Acetate