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Cited by 126Reproductive Health and ContraceptionBone health and osteoporosis researchMenopause: Health Impacts and Treatments

Bone mineral density changes over two years in first-time users of depot medroxyprogesterone acetate

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Clark, M. Kathleen, Sowers, MaryFran R., Nichols, Sara, Levy, Barcey·2004·Fertility and Sterility
DOI 10.1016/j.fertnstert.2004.04.064
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Abstract

Objective To compare longitudinal changes in bone mineral density (BMD) among first-time depot medroxyprogesterone acetate (DMPA) users to women using no hormonal contraception, and evaluate user characteristics associated with that BMD change.Design Prospective longitudinal study.Setting Healthy volunteers in an academic research environment.Patient(s) Women, aged 18 to 35, choosing DMPA for contraception (n = 178) and women using no hormonal contraception (n = 145).Main outcome measure(s) Hip and spine BMD measured, at three-month intervals for 24 months, by dual energy x-ray absorptiometry.Result(s) Mean hip BMD declined 2.8% (SE = 0.034) 12 months following DMPA initiation and 5.8% (SE = 0.096) after 24 months. Mean spine (L1-L3) BMD declined 3.5% (SE = 0.022) and 5.7% (SE = 0.034), respectively, after one and two years of DMPA use. Mean hip and spine BMD of control participants changed less than 0.9% over the same period. Among DMPA users, body mass index (BMI) change was inversely associated with BMD change at the hip, but not at the spine. Calcium intake, physical activity, and smoking did not influence BMD change in either group.Conclusion(s) Hip and spine BMD declined after one DMPA injection and this decline continued with each subsequent injection for 24 months. With the exception of increasing BMI among DMPA users, no user characteristics offered protection against DMPA-related BMD loss.

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  • Prolonged DMPA use is associated with decrease in BMD and increased risk of fracture due to estrogen deficiency.

    “One of major sources of concerns regarding prolonged use of DMPA is the decrease of BMD and the increase risk of fracture, due to estrogen deficiency accompanying its use.”

    From Oral and depot progestin therapy for endometriosis: towards a personalized medicine (2017) · cites this paper as [59]

  • The negative impact of DMPA on bone mineral density is reversible toward or to baseline values within two years after discontinuation.

    “reversibility of the negative impact of DMPA on BMD toward or to baseline values within two years after discontinuation has been demonstrated in numerous studies [59,61,65,68].”

    From Oral and depot progestin therapy for endometriosis: towards a personalized medicine (2017) · cites this paper as [59]

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Research works printed but not linked: 2

  1. Lenchik L, Rochmis P, Sartoris D. Optimized interpretation and report- ing of dual x-ray absorptionmetry (DXA) scans. Am J Radiology 1998;171:1509 -20.
  2. Samojlik E, Kirshner E, Samojlik M, Drejka E, Szmal G, Schneider G, et al. Elevated production and metabolic clearance rates of androgen in morbidly obese women. J Clin Endocrinol Metab 1990;49:949 -54.

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Authors
Clark, M. K., Sowers, M. R., Nichols, S., & Levy, B.
Affiliations
  • University of Iowa (US)
  • University of Michigan (US)
Corresponding author
Clark, M. Kathleen
ORCID
Levy, Barcey
Venue
Fertility and Sterility
Publisher
Elsevier BV
Published
2004-12
Volume
82
Issue
6
Pages
1580-1586
ISSN
0015-0282 (ISSN-L)
DOI
10.1016/j.fertnstert.2004.04.064
OpenAlex
W2128538962
Cited by
126
References
31
Citations by year
2026: 2 · 2024: 3 · 2023: 2 · 2022: 1 · 2021: 4 · 2020: 7 · 2019: 5 · 2018: 2 · 2017: 5 · 2016: 5 · 2015: 8 · 2014: 5 · 2013: 9 · 2012: 4
FWCI
8.83
Type
journal article
Language
en
Open access
Licence
Locations
  • Fertility and Sterility (publishedVersion)
  • PubMed (publishedVersion)
  • Iowa Research Online (The University of Iowa) (submittedVersion)
Funders
  • National Institutes of Health (NICHD‐R01)
  • U.S. Public Health Service (R01 39100)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Reproductive Health and Contraception
  • Health Sciences › Medicine › Orthopedics and Sports Medicine › Bone health and osteoporosis research
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Menopause: Health Impacts and Treatments
Keywords
depot medroxyprogesterone acetate, bone mineral density, bone loss, hormonal contraception, hip bone density, spine bone density, body mass index, calcium intake, physical activity, smoking, young women
MeSH terms
Adult, Contraceptive Agents, Female, Delayed-Action Preparations, Female, Hip Joint, Humans, Longitudinal Studies, Prospective Studies, Spine, Cohort Studies, Absorptiometry, Photon, Bone Density, Body Mass Index, Medroxyprogesterone Acetate

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