title: Update on hormonal contraception and bone density.
abstract: Combination hormonal contraception and progestin-only contraception (including depot medroxyprogesterone acetate [DMPA]) are effective and convenient forms of reversible contraception that millions of women use worldwide. In recent years, observations of reduced bone mineral density in current users of these methods have led to concerns that this hormone-induced bone loss might translate into long-term increased fracture risk. Special focus has been placed on adolescent users who have not yet attained their peak bone mass as well as perimenopausal users. In 2004, the FDA added a black box warning to DMPA package labeling warning of the risk of significant bone loss and cautioning against long-term use (> 2 years). This article reviews evidence on the use of hormonal contraception and its effect on bone density in adolescent, premenopausal, and perimenopausal populations. Recommendations from reproductive healthcare organizations are reviewed and clinical recommendations are provided.
authors.affiliation: Department of Obstetrics and Gynecology, The Ohio State University, Columbus, USA. Michelle.Isley@osumc.edu
authors.forename: Michelle M
authors.initials: MM
authors.lastname: Isley
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Kaunitz
mesh_terms: D000293:Adolescent; D000328:Adult; D015519:Bone Density / Q000187:drug effects*; D003271:Contraceptive Agents, Female / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D003277:Contraceptives, Oral, Combined / Q000009:adverse effects / Q000627:therapeutic use; D003278:Contraceptives, Oral, Hormonal / Q000009:adverse effects* / Q000627:therapeutic use; D005260:Female; D050723:Fractures, Bone / Q000139:chemically induced / Q000453:epidemiology; D006801:Humans; D007774:Lactation; D047648:Perimenopause; D017410:Practice Guidelines as Topic; D012307:Risk Factors; D055815:Young Adult
chemical_list: D003271:Contraceptive Agents, Female; D003277:Contraceptives, Oral, Combined; D003278:Contraceptives, Oral, Hormonal