Inadequate vitamin D status in adolescents with substantial bone mineral density loss during the use of depot medroxyprogesterone acetate injectable contraceptive: A pilot study

Z. Harel, K. Wolter, M. A. Gold, B. Cromer, A. Bruner, M. Stager, L. Bachrach, P. Hertweck, A. Nelson, D. Nelson, S. Coupey, C. C. Johnson, R. Burkman, H. Bone

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Abstract

Study Objective: To examine vitamin D and parathormone (PTH) levels in adolescents who experienced substantial bone mineral density (BMD) loss during depot medroxyprogesterone acetate (DMPA) use. Design: A non-randomized, multi-center study, during which DMPA was administered every 12 weeks and evaluation of lumbar spine and hip BMD by dual-energy X-ray absorptiometry (DXA) was conducted every 6 months. A blood sample for vitamin D and PTH measurements was obtained from adolescents who experienced >5% BMD loss. Vitamin D deficiency was defined as 25-hydroxyvitamin D (25OHD) level of <20ng/mL, insufficiency as 25OHD level of 20-30ng/mL, and sufficiency as 25OHD level of >30ng/mL. Results: Evaluation of vitamin D and PTH was carried out in 15 participants who experienced BMD loss of ≥5% during DMPA use. At initiation of DMPA, participants had mean (+SE) age 17+1years, gynecologic age 61+4 months, and body mass index 24+1.5kg/m2. Racial/ethnic distribution was: Caucasian-7 girls, Hispanic-4 girls, African-American-3 girls, and other-1 girl. Six participants had BMD loss of >5% after 2 DMPA injections, five after 3 injections, one after 5 injections, one after 8 injections, one after 10 injections, and one after 13 injections. Only one girl (7%) had sufficient vitamin D. The other participants had vitamin D insufficiency (50%) or deficiency (43%). Participants' mean (+SE) PTH was 22+4pg/mL (reference range 7-53pg/mL), and mean (+SE) 1,25-dihydroxyvitamin D was 56+5pg/mL (reference range 22-67pg/mL). Conclusions: Inadequate vitamin D status was evident among the majority of female adolescents who experienced a substantial BMD loss while using DMPA.

Original languageEnglish (US)
Pages (from-to)209-214
Number of pages6
JournalJournal of Pediatric and Adolescent Gynecology
Volume23
Issue number4
DOIs
Publication statusPublished - Aug 1 2010

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Keywords

  • Adolescents
  • Bone mineral density
  • Female
  • Med roxyprogesterone acetate (DMPA, Depo-Provera)
  • Vitamin D

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Obstetrics and Gynecology

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