Inadequate vitamin D status in adolescents with substantial bone mineral density loss during the use of depot medroxyprogesterone acetate injectable contraceptive: a pilot study.
OBJECTIVE
To examine vitamin D and parathormone (PTH) levels in adolescents who experienced substantial bone mineral density (BMD) loss during depot medroxyprogesterone acetate (DMPA) use.


METHODS
A non-randomized, multi-center study, during which DMPA was administered every 12 weeks and evaluation of lumbar spine and hip BMD by dual-energy X-ray absorptiometry (DXA) was conducted every 6 months. A blood sample for vitamin D and PTH measurements was obtained from adolescents who experienced >5% BMD loss. Vitamin D deficiency was defined as 25-hydroxyvitamin D (25OHD) level of <20 ng/mL, insufficiency as 25OHD level of 20-30 ng/mL, and sufficiency as 25OHD level of >30 ng/mL.


RESULTS
Evaluation of vitamin D and PTH was carried out in 15 participants who experienced BMD loss of > or = 5% during DMPA use. At initiation of DMPA, participants had mean (+SE) age 17+1 years, gynecologic age 61+4 months, and body mass index 24+1.5 kg/m2. Racial/ethnic distribution was: Caucasian--7 girls, Hispanic--4 girls, African-American--3 girls, and other--1 girl. Six participants had BMD loss of >5% after 2 DMPA injections, five after 3 injections, one after 5 injections, one after 8 injections, one after 10 injections, and one after 13 injections. Only one girl (7%) had sufficient vitamin D. The other participants had vitamin D insufficiency (50%) or deficiency (43%). Participants' mean (+SE) PTH was 22+4 pg/mL (reference range 7-53 pg/mL), and mean (+SE) 1,25-dihydroxyvitamin D was 56+5 pg/mL (reference range 22-67 pg/mL).


CONCLUSIONS
Inadequate vitamin D status was evident among the majority of female adolescents who experienced a substantial BMD loss while using DMPA.
Harel
Z
Z
Division of Adolescent Medicine, Hasbro Children's Hospital and Brown University, Providence, RI 02903, USA. Zharel@Lifespan.org
Wolter
K
K
Gold
M A
MA
Cromer
B
B
Bruner
A
A
Stager
M
M
Bachrach
L
L
Hertweck
P
P
Nelson
A
A
Nelson
D
D
Coupey
S
S
Johnson
C C
CC
Burkman
R
R
Bone
H
H
D000293:Adolescent; D015519:Bone Density / Q000187:drug effects*; D001851:Bone Diseases, Metabolic / Q000209:etiology*; D003271:Contraceptive Agents, Female / Q000009:adverse effects*; D004343:Drug Implants; D005260:Female; D006801:Humans; D017258:Medroxyprogesterone Acetate / Q000009:adverse effects*; D010281:Parathyroid Hormone / Q000097:blood; D010865:Pilot Projects; D014807:Vitamin D / Q000097:blood; D014808:Vitamin D Deficiency / Q000150:complications*
D003271:Contraceptive Agents, Female; D004343:Drug Implants; D010281:Parathyroid Hormone; D014807:Vitamin D; D017258:Medroxyprogesterone Acetate