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.
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
Zeev
Z
Harel
Christine Cole
CC
Johnson
Melanie A
MA
Gold
Barbara
B
Cromer
Edward
E
Peterson
Ronald
R
Burkman
Margaret
M
Stager
Robert
R
Brown
Ann
A
Bruner
Susan
S
Coupey
Paige
P
Hertweck
Henry
H
Bone
Kevin
K
Wolter
Anita
A
Nelson
Sharon
S
Marshall
Laura K
LK
Bachrach
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