Further evaluation on long-term depot-medroxyprogesterone acetate use and bone mineral density: a longitudinal cohort study

Bone mineral density loss and recovery during 48 months in first-time users of depot medroxyprogesterone acetate

“…Consistent with the other longitudinal studies evaluating BMD and depot MPA use (3)(4)(5)(6), attrition was substantial. Despite the smaller sample size with extended use, we had a sufficient number of participants continuing depot MPA use to detect significant BMD change.…”

Update on hormonal contraception and bone density

“…In another study of Chinese women, where the mean age of DMPA users was 43 years, 67 DMPA users of 5-15 years were found to have significantly decreased BMD at the spine and hip, compared to 218 nonusers (mean age 40) [45]. The investigators then prospectively followed 59 of the 67 DMPA subjects from this study to examine the rate of bone loss over 3 years [46]. They found that the rate of bone loss actually seen was less than expected, suggesting the BMD loss associated with DMPA use is non-linear, and is more rapid during the first years of use, but attenuates with time.…”

“…They found that the rate of bone loss actually seen was less than expected, suggesting the BMD loss associated with DMPA use is non-linear, and is more rapid during the first years of use, but attenuates with time. Tang et al concluded that duration of DMPA use was not significantly correlated with the rate of bone loss [46].…”

“…In a cross sectional study of 352 perimenopausal women aged 40 to 54 years, Fortney et al found that longer-duration as well as current COC use was associated with a nonsignificant increase in spinal BMD [86]. In another cross sectional study of perimenopausal women (age 40-49 years), Beksinska et al found that BMD at the distal radius and ulna was similar among COC users and women who had not used hormonal contraception [46]. A case series of 37 perimenopausal women (ages 45-48) who used a COC for 24 months also demonstrated no significant increase in spine BMD [87].…”

Pharmacologic Doses of Medroxyprogesterone May Cause Bone Loss Through Glucocorticoid Activity: An Hypothesis

“…Unfortunately, there is also evidence to suggest that long-term use of progestins is associated with lower bone density levels [24][25][26][27][28]. For example, adult premenopausal women receiving long-acting injectable contraceptive depot-medroxyprogesterone acetate (DMPA) (150 mg every 10-12 weeks) had a lower bone mass than a similar group not receiving the hormone [29][30][31], and Cromer et al [32] found that in adolescent girls injectable DMPA decreased the skeletal bone density while levonorgestrel increased the bone density in similar fashion to that in the oral contraceptives (e.g., estrogen-progesterone acetate) and control groups.…”