title: Biopsychosocial variables associated with substantial bone mineral density loss during the use of depot medroxyprogesterone acetate in adolescents: adolescents who lost 5% or more from baseline vs. those who lost less than 5%.
abstract: BACKGROUND
  It is unclear why some adolescents experience substantial bone mineral density (BMD) loss, while others experience a minimal decrease during depot medroxyprogesterone acetate (DMPA) use. We examined biopsychosocial factors in adolescents who experienced ≥5% BMD loss from baseline compared with adolescents who experienced <5% BMD loss during DMPA use.
  
  
  METHODS
  A multicenter, prospective, nonrandomized study of 181 female adolescents who initiated DMPA for contraception was conducted. BMD (by dual-energy X-ray absorptiometry) and serum estradiol were measured at initiation and every 6 months for 240 weeks of DMPA use.
  
  
  RESULTS
  Half of participants experienced BMD loss of ≥5% from baseline at the hip, and a quarter experienced BMD loss of ≥5% at the lumbar spine (BMD substantial losers, SL). Hip and lumbar spine BMD-SL received a significantly greater number of DMPA injections than non-SL (p<.001). Decreased estradiol levels did not statistically differ between BMD loss subgroups. Hip BMD-SL had significantly lower baseline body mass index (BMI) than non-SL (p=.002), and there was an inverse relationship between weight gain and degree of BMD loss. Mean calcium intake was significantly lower (p<.05) in hip BMD-SL, and reported alcohol use was significantly higher (p<.05) in lumbar spine BMD-SL compared with non-SL.
  
  
  CONCLUSIONS
  BMD loss of ≥5% was more common at the hip than at the lumbar spine among adolescents using DMPA. Decreased serum estradiol levels did not correlate with magnitude of BMD loss. Lower BMI and calcium intake and greater alcohol use were associated with greater BMD loss in adolescents using DMPA.
authors.affiliation: 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
authors.forename: Zeev
authors.initials: Z
authors.lastname: Harel
authors.forename: Kevin
authors.initials: K
authors.lastname: Wolter
authors.forename: Melanie A
authors.initials: MA
authors.lastname: Gold
authors.forename: Barbara
authors.initials: B
authors.lastname: Cromer
authors.forename: Margaret
authors.initials: M
authors.lastname: Stager
authors.forename: Christine Cole
authors.initials: CC
authors.lastname: Johnson
authors.forename: Robert
authors.initials: R
authors.lastname: Brown
authors.forename: Ann
authors.initials: A
authors.lastname: Bruner
authors.forename: Susan
authors.initials: S
authors.lastname: Coupey
authors.forename: Paige
authors.initials: P
authors.lastname: Hertweck
authors.forename: Henry
authors.initials: H
authors.lastname: Bone
authors.forename: Ronald
authors.initials: R
authors.lastname: Burkman
authors.forename: Anita
authors.initials: A
authors.lastname: Nelson
authors.forename: Sharon
authors.initials: S
authors.lastname: Marshall
authors.forename: Laura K
authors.initials: LK
authors.lastname: Bachrach
mesh_terms: D000293:Adolescent; D000428:Alcohol Drinking / Q000503:physiopathology / Q000523:psychology; D015519:Bone Density / Q000187:drug effects*; D002648:Child; D015331:Cohort Studies; D003271:Contraceptive Agents, Female / Q000008:administration & dosage / Q000009:adverse effects*; D003692:Delayed-Action Preparations; D004958:Estradiol / Q000097:blood; D005260:Female; D006621:Hip Joint / Q000187:drug effects; D006801:Humans; D008159:Lumbar Vertebrae / Q000187:drug effects; D017258:Medroxyprogesterone Acetate / Q000008:administration & dosage / Q000009:adverse effects*; D011446:Prospective Studies; D012907:Smoking / Q000503:physiopathology / Q000523:psychology
chemical_list: D003271:Contraceptive Agents, Female; D003692:Delayed-Action Preparations; D004958:Estradiol; D017258:Medroxyprogesterone Acetate