Recovery of bone mineral density in adolescents following the use of depot medroxyprogesterone acetate contraceptive injections.
BACKGROUND
Depot medroxyprogesterone acetate (DMPA) is a highly effective progestin-only contraceptive that is widely used by adolescents. We investigated bone mineral density (BMD) changes in female adolescents during and following use of this method.


METHODS
A multicenter, prospective, non-randomized observational study in 98 healthy female adolescents aged 12-18 years who initiated DMPA intramuscular injections for contraception and provided BMD data for up to 240 weeks while receiving DMPA and for up to 300 weeks after DMPA cessation. BMD at the lumbar spine (LS), total hip (TH) and femoral neck (FN) was assessed by dual-energy X-ray absorptiometry. A mixed model analysis of variance was used to examine BMD changes.


RESULTS
At the time of their final DMPA injection, participants had mean BMD declines from baseline of 2.7% (LS), 4.1% (TH) and 3.9% (FN) (p<.001 at all three sites). Within 60 weeks of discontinuation of DMPA, mean LS BMD had returned to baseline levels, and 240 weeks after DMPA discontinuation, the mean LS BMD was 4.7% above baseline. Mean TH and FN BMD values recovered to baseline values more slowly: 240 weeks and 180 weeks, respectively, after the last DMPA injection.


CONCLUSIONS
BMD loss in female adolescents receiving DMPA for contraception is substantially or fully reversible in most girls following discontinuation of DMPA, with faster recovery at the LS than at the hip.
Harel
Zeev
Z
Division of Adolescent Medicine, Hasbro Children's Hospital and Department of Pediatrics, Warren Alpert Medical School of Brown University, Providence, RI 02903, USA. zharel@lifespan.org
Johnson
Christine Cole
CC
Gold
Melanie A
MA
Cromer
Barbara
B
Peterson
Edward
E
Burkman
Ronald
R
Stager
Margaret
M
Brown
Robert
R
Bruner
Ann
A
Coupey
Susan
S
Hertweck
Paige
P
Bone
Henry
H
Wolter
Kevin
K
Nelson
Anita
A
Marshall
Sharon
S
Bachrach
Laura K
LK
D000293:Adolescent; D000428:Alcohol Drinking / Q000009:adverse effects; D015992:Body Mass Index; D015519:Bone Density / Q000187:drug effects*; D002648:Child; D003280:Contraceptives, Oral, Synthetic / Q000008:administration & dosage / Q000009:adverse effects*; D003692:Delayed-Action Preparations / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D017258:Medroxyprogesterone Acetate / Q000008:administration & dosage / Q000009:adverse effects*; D011247:Pregnancy; D011253:Pregnancy in Adolescence / Q000517:prevention & control*; D011446:Prospective Studies; D012907:Smoking / Q000009:adverse effects
D003280:Contraceptives, Oral, Synthetic; D003692:Delayed-Action Preparations; D017258:Medroxyprogesterone Acetate