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Cited by 187Reproductive Health and ContraceptionBone health and osteoporosis researchMenopause: Health Impacts and Treatments

Injectable Hormone Contraception and Bone Density: Results from a Prospective Study

Scholes, Delia, LaCroix, Andrea Z., Ichikawa, Laura E., Barlow, William E., Ott, Susan M.·2002·Epidemiology
DOI 10.1097/00001648-200209000-00015
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Abstract

BACKGROUND: Depot medroxyprogesterone acetate (DMPA) injectable contraception may decrease bone density and increase the risk for osteoporosis in later life. Prospective data are scarce, especially of the effects of DMPA discontinuation on bone. METHODS: Between 1994 and 1999, we conducted a population-based prospective cohort study among women enrollees of a Washington State health maintenance organization. We enrolled 457 nonpregnant women, ages 18-39 years (183 DMPA users and 274 non-users). Bone density was measured by dual-energy x-ray absorptiometry every 6 months for 3 years. RESULTS: Bone density decreased notably among DMPA-exposed women at the spine (adjusted mean bone density was -0.0053 gm/cm for DMPA users compared with +0.0023 gm/cm for non-users for each 6-month interval) and total hip (-0.0060 compared with -0.0002 gm/cm ). This represents an annualized mean rate of change at the spine of -0.87% compared with +0.40% and, at the hip, -1.12% compared with -0.05%. Discontinuers of this method (N = 110) showed sizable increases in bone density over comparison women (for each 6-month interval, adjusted mean spine bone density was +0.0067 gm/cm compared with +0.0023 gm/cm, respectively; adjusted mean hip bone density was +0.0035 compared with -0.0002 gm/cm ). Estimated annualized mean rates of change were +1.41% compared with +0.40% [corrected] at the spine and +1.03% [corrected] compared with -0.05% at the hip. After 30 months, mean bone density for discontinuers was similar to that of non-users. CONCLUSIONS: In this study, DMPA use was strongly associated with bone density loss. Substantial postdiscontinuation recovery of bone provides evidence that the effects may be largely reversible.

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Crossref · 10.1097/00001648-200209000-00015

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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 [56]

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Authors
Scholes, D., LaCroix, A. Z., Ichikawa, L. E., Barlow, W. E., & Ott, S. M.
Affiliations
  • Group Health Cooperative (US)
  • University of Washington (US)
Corresponding author
Scholes, Delia
ORCID
Venue
Epidemiology
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2002-09
Volume
13
Issue
5
Pages
581-587
ISSN
1044-3983 (ISSN-L)
DOI
10.1097/00001648-200209000-00015
OpenAlex
W1984063724
Cited by
187
References
34
Citations by year
2026: 1 · 2025: 1 · 2024: 5 · 2023: 5 · 2022: 3 · 2021: 3 · 2020: 6 · 2019: 3 · 2018: 1 · 2017: 3 · 2016: 4 · 2015: 5 · 2014: 7 · 2013: 7 · 2012: 3
FWCI
13.53
Type
journal article
Language
en
Open access
closed
Locations
  • Epidemiology (publishedVersion)
  • PubMed (publishedVersion)
  • eScholarship (California Digital Library) (submittedVersion)
Funders
  • U.S. Food and Drug Administration
  • Eunice Kennedy Shriver National Institute of Child Health and Human Development (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, injectable contraceptives, bone mineral density, bone loss, osteoporosis risk, contraceptive discontinuation, bone recovery, spine bone density, hip bone density, women of reproductive age
MeSH terms
Adolescent, Adult, Contraceptive Agents, Female, Delayed-Action Preparations, Female, Humans, Injections, Osteoporosis, Prospective Studies, Cohort Studies, Absorptiometry, Photon, Bone Density, Medroxyprogesterone Acetate

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