Effects of Depot Medroxyprogesterone Acetate and 20-Microgram Oral Contraceptives on Bone Mineral Density

Abstract

OBJECTIVE Hormonal contraceptives may adversely affect bone mineral density . However, racial differences and the reversibility of these changes are poorly understood. This study measured bone mineral density changes during hormonal contraceptive use and after discontinuation in a triethnic population. METHODS Bone mineral density was measured every 6 months for up to 3 years in 703 white, black, and Hispanic women using oral contraceptives (OCPs), depot medroxyprogesterone acetate (DMPA), or nonhormonal contraception, and in 68 DMPA discontinuers for up to 2 additional years. Mixed-model regression analyses were used to estimate the percentage change in bone mineral density for each contraceptive method. RESULTS Over 3 years, DMPA and OCP users lost more bone mineral density than nonhormonal contraception users (−3.7% and −0.5% vs. +1.9% at lumbar spine, and −5.2% and −1.3% vs. +0.6% at femoral neck, respectively). No differences were observed by race in bone mineral density changes that resulted from DMPA or OCP use. However, DMPA users aged 16–24 years lost more bone mineral density at the spine (4.2% vs. 3.2%, P=.006) and femoral neck (6.0% vs. 4.2%, P=.001) than those aged 25–33 years. After DMPA discontinuation, women who selected nonhormonal contraception gained bone mineral density (+4.9% at spine; +3.2% at femoral neck) while those who selected OCP recovered spinal (+2.3%), but not femoral neck bone mineral density (−0.7%). CONCLUSIONS Use of very low-dose OCP may result in a small amount of bone loss. DMPA use results in greater bone loss, but this is largely reversible at the spine. Use of very low-dose OCPs after DMPA discontinuation may slow bone recovery.

Contraception for Adolescents

“…Since that time, 3 publications have described prospective studies of adolescent and young adult women during and after use of DMPA. [110][111][112] …”

Update on hormonal contraception and bone density

“…Over 3 years of follow-up, DMPA users had the highest BMD loss at the spine during the first year, with the loss slowing during the second and third years. Age was found to be an important determinant of BMD change: DMPA users aged 16-24 years lost significantly more BMD at the spine (4.2% vs 3.2%, p=0.006) and femoral neck (6.0% vs 4.2%, p=0.001) than those aged 25-33 years [35]. The investigators followed DMPA discontinuers over 2 years and found those women who used non-hormonal methods after DMPA discontinuation experienced faster BMD recovery at both the spine (4.9% vs 2.3%) and the femoral neck (3.2% vs −0.7%) than those who chose COCs.…”

“…However, women who used DMPA for longer durations regained BMD more rapidly after DMPA discontinuation than those using the drug for a shorter time. [35].…”

“…At the femoral neck, increase in adjusted bone mineral content was significantly lower in the COCs users of more than 2 years compared with COC users of 1-2 years (p for linearity=0.038) [63]. Berenson et al enrolled women aged 16-33 and followed them every 6 months for up to 3 years [35]. COC users (20 mcg EE formulation) lost more BMD than non-hormonal users, but this difference was minimal (−0.54% COC users vs. +1.94% non-users at lumbar spine, −1.29% COC users vs. +0.61% non-users at femoral neck).…”

Self-Perception of Weight Gain Among Multiethnic Reproductive-Age Women

“…[22][23][24] Briefly, as part of a larger study, 805 non-Hispanic black, non-Hispanic white, and Hispanic women between 16 and 33 years of age were recruited between October 9, 2001, and September 14, 2004, to examine the effect of hormonal contraceptives on bone mineral density. Women were recruited from those who responded to advertisements and mailed announcements.…”