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Cited by 141Reproductive Health and ContraceptionBone health and osteoporosis researchMenopause: Health Impacts and Treatments

Bone mineral density in women using depot medroxyprogesterone acetate for contraception

Scholes, D·1999·Obstetrics & Gynecology
DOI 10.1016/s0029-7844(98)00447-5
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Abstract

OBJECTIVE: To evaluate the possible effects of depot medroxyprogesterone acetate injectable contraception on bone mineral density in reproductive-age women. METHODS: We conducted a population-based cross-sectional comparison of bone mineral density levels in women using depot medroxyprogesterone acetate contraception and in women of similar age not using this method. The study recruited 457 nonpregnant women aged 18-39 years who were enrollees of a Washington state health maintenance organization. One hundred eighty-three women were receiving injections and 274 were not. Bone mineral density at several anatomic sites (spine, femoral neck, greater trochanter, and whole body) was measured using dual-energy x-ray absorptiometry. Data on other factors potentially related to bone density were collected through questionnaire and examination. RESULTS: Overall, age-adjusted mean bone density levels were lower for users of this method than for nonusers at all anatomic sites: The mean difference was 2.5% for the spine (P = .03) and 2.2% for the femoral neck (P = .12). Exposure to depot medroxyprogesterone acetate continued to be significantly (P < .01) associated with decreased bone density at the femoral neck, spine, and trochanter after multivariate adjustment for other risk factors related to bone density. Age-specific comparisons indicated that the major differences in bone density between users and nonusers occurred in the youngest age group (women 18-21 years); the mean femoral neck bone density was 10.5% lower (P < .01) for the exposed women, and differences were consistent (P < .01) across all anatomic sites. We also noted a significant dose-response relation between longer use of depot medroxyprogesterone acetate and decreased bone density levels in this age group (P < .01 for all sites). CONCLUSION: These results provide evidence that contraception with depot medroxyprogesterone acetate, particularly long-term use, may adversely affect bone mineral density levels in young women aged 18-21 years. The implications for future bone health need further study.

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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 [54]

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Authors
Scholes, D.
Affiliations
Group Health Cooperative (US)
Corresponding author
Scholes, D
Venue
Obstetrics & Gynecology
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
1999-02
Volume
93
Issue
2
Pages
233-238
ISSN
0029-7844 (ISSN-L)
DOI
10.1016/s0029-7844(98)00447-5
OpenAlex
W1974936404
Cited by
141
References
23
Citations by year
2022: 1 · 2020: 1 · 2019: 2 · 2018: 1 · 2017: 4 · 2016: 3 · 2015: 1 · 2014: 2 · 2013: 3 · 2012: 3
FWCI
13.05
Type
journal article
Language
en
Open access
closed
Locations
  • Obstetrics and Gynecology (publishedVersion)
  • PubMed (publishedVersion)
  • eScholarship (California Digital Library) (submittedVersion)
Funders
Eunice Kennedy Shriver National Institute of Child Health and Human Development (HD31165, R01HD031165)
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, injectable contraceptives, osteoporosis risk, young women, femoral neck, spine, dose-response relationship, long-term contraceptive use, women of reproductive age
MeSH terms
Adolescent, Adult, Contraceptive Agents, Female, Cross-Sectional Studies, Delayed-Action Preparations, Female, Femur, Humans, Spine, Absorptiometry, Photon, Bone Density, Medroxyprogesterone Acetate

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