Bone density in women receiving depot medroxyprogesterone acetate for contraception.

Abstract

Objective-To determine if the use of the injectable contraceptive depot medroxyprogesterone (DMPA), which reduces ovarian oestrogen production, is associated with changes in bone density.Design-Population study. DMPA Main outcome measure-Lumbar spine and femoral neck bone mineral density assessed by dual energy x ray absorptiometry.Results-Compared with premenopausal controls matched for age, race, and body mass index, DMPA users had significantly reduced bone density in the lumbar spine (mean difference 7 5% (95% confidence interval 1-9% to 13-1%), p=0.002) and in the femoral neck (6-6%, (0.8% to 12-3%), p=0007). Compared with postmenopausal controls matched for body mass index and duration of oestrogen deficiency, DMPA users had greater bone density in the lumbar spine (8-9% (4.3% to 13.5%), p=0001), but in the femoral neck the difference in bone density was less (4-0% (-0-4% to 8.5%), p=004).

Best Practices in Managing Transition to Adulthood for Adolescents With Congenital Heart Disease: The Transition Process and Medical and Psychosocial Issues

“…116 Additionally, the risk of osteoporosis associated with amenorrhea with long-term use is of concern. 117,118 Although there are no specific guidelines for teens, it is generally recommended that females who use this method for Ͼ2 years or who smoke or are extremely thin should be monitored regularly for bone density loss and be prescribed calcium supplements (1200 to 1500 mg/d). The contraceptive implant Implanon is a favorable choice for teens with compliance issues or for patients for whom pregnancy is contraindicated but who are not yet ready to undergo permanent sterilization.…”

Drug-Induced Bone Loss

“…In contrast, some studies have failed to show the bene®t of MPA in preventing bone loss in such women [261]. In premenopausal women given progestrogens, trabecular bone loss occurs [262,263]. Dual-energy X-ray absorptiometry (DXA) measurements of the lumbar spine show progressive decreases of 2.4% at 6 months and 4.1% at 12 months [263].…”

Contraceptive provision for the older woman

“…Cundy et al [6] reported a cross-sectional study of long-term DMPA users who volunteered to have their bone density measured, and found it was lower than the age-matched general population. There was no correlation between duration of DMPA use and their reduction in bone density.…”