Recovery of bone mineral density in adolescents following the use of depot medroxyprogesterone acetate contraceptive injections

Received 3 September 2009; received in revised form 5 November 2009; accepted 9 November 2009. published online 14 December 2009.

Abstract

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.

Study Design

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.

Keywords: Adolescents, Bone density, Contraceptive agents, Depot medroxyprogesterone acetate

a Division of Adolescent Medicine/Hasbro Children’s Hospital and Department of Pediatrics/Warren Alpert Medical School of Brown University, Providence, RI 02903, USA

b Department of Biostatistics and Research Epidemiology/Henry Ford Health System, Detroit, MI 48202-3450, USA

c Division of Student Affairs/University of Pittsburgh Student Health Service and Division of Adolescent Medicine/Department of Pediatrics/University of Pittsburgh, Pittsburgh, PA 15213, USA

d Division of Adolescent Medicine/MetroHealth Medical Center and Department of Pediatrics/Case Western Reserve University School of Medicine, Cleveland, OH 44109-1998, USA

e Division of General Obstetrics and Gynecology/Department of Obstetrics and Gynecology/Baystate Medical Center, Springfield, MA 01199, USA

f Department of Pediatrics/Ohio State University College of Medicine, Columbus, OH 43210, USA

g Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA

h Division of Adolescent Medicine/Children’s Hospital at Montefiore, and Albert Einstein College of Medicine, New York, NY 10467, USA

i Department of Obstetrics, Gynecology & Women Health/University of Louisville School of Medicine, Louisville, KY 40202, USA

j Michigan Bone and Mineral Clinic, Detroit, MI 48236, USA

k Pfizer Global Research & Development, New London, CT 06320, USA

l Department of Obstetrics and Gynecology, Harbor-UCLA Medical Center, Torrance, CA 90509-2910, USA

m Division of Adolescent Medicine/Children’s Hospital of Michigan and Wayne State University School of Medicine, Detroit, MI 48201, USA

n Division of Pediatric Endocrinology/Stanford University School of Medicine, Stanford, CA 94305-5208, USA

Corresponding author. Division of Adolescent Medicine/Hasbro Children's Hospital, Providence, RI 02903, USA.

PII: S0010-7824(09)00487-9

doi:10.1016/j.contraception.2009.11.003

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