Recovery of bone mineral density in adolescents following the use of depot medroxyprogesterone acetate contraceptive injections

Zeev Harel, Christine Cole Johnson, Melanie A. Gold, Barbara Cromer, Edward Peterson, Ronald Burkman, Margaret Stager, Robert Brown, Ann Bruner, Susan M. Coupey, Paige Hertweck, Henry Bone, Kevin Wolter, Anita Nelson, Sharon Marshall, Laura K. Bachrach

Research output: Contribution to journalArticle

67 Citations (Scopus)

Abstract

Background: Depot medroxyprogesterone acetate (DMPA) is a highly effective progestin-only contraceptive that is widely used by adolescents. We investigated bone mineral density (BMD) changes in female adolescents during and following use of this method. Study Design: A multicenter, prospective, non-randomized observational study in 98 healthy female adolescents aged 12-18 years who initiated DMPA intramuscular injections for contraception and provided BMD data for up to 240 weeks while receiving DMPA and for up to 300 weeks after DMPA cessation. BMD at the lumbar spine (LS), total hip (TH) and femoral neck (FN) was assessed by dual-energy X-ray absorptiometry. A mixed model analysis of variance was used to examine BMD changes. Results: At the time of their final DMPA injection, participants had mean BMD declines from baseline of 2.7% (LS), 4.1% (TH) and 3.9% (FN) (p<.001 at all three sites). Within 60 weeks of discontinuation of DMPA, mean LS BMD had returned to baseline levels, and 240 weeks after DMPA discontinuation, the mean LS BMD was 4.7% above baseline. Mean TH and FN BMD values recovered to baseline values more slowly: 240 weeks and 180 weeks, respectively, after the last DMPA injection. Conclusions: BMD loss in female adolescents receiving DMPA for contraception is substantially or fully reversible in most girls following discontinuation of DMPA, with faster recovery at the LS than at the hip.

Original languageEnglish (US)
Pages (from-to)281-291
Number of pages11
JournalContraception
Volume81
Issue number4
DOIs
StatePublished - Apr 2010
Externally publishedYes

Fingerprint

Medroxyprogesterone Acetate
Contraceptive Agents
Bone Density
Injections
Spine
Hip
Femur Neck
Contraception
Intramuscular Injections
Photon Absorptiometry
Progestins
Observational Studies
Analysis of Variance

Keywords

  • Adolescents
  • Bone density
  • Contraceptive agents
  • Depot medroxyprogesterone acetate

ASJC Scopus subject areas

  • Reproductive Medicine
  • Obstetrics and Gynecology

Cite this

Recovery of bone mineral density in adolescents following the use of depot medroxyprogesterone acetate contraceptive injections. / Harel, Zeev; Johnson, Christine Cole; Gold, Melanie A.; Cromer, Barbara; Peterson, Edward; Burkman, Ronald; Stager, Margaret; Brown, Robert; Bruner, Ann; Coupey, Susan M.; Hertweck, Paige; Bone, Henry; Wolter, Kevin; Nelson, Anita; Marshall, Sharon; Bachrach, Laura K.

In: Contraception, Vol. 81, No. 4, 04.2010, p. 281-291.

Research output: Contribution to journalArticle

Harel, Z, Johnson, CC, Gold, MA, Cromer, B, Peterson, E, Burkman, R, Stager, M, Brown, R, Bruner, A, Coupey, SM, Hertweck, P, Bone, H, Wolter, K, Nelson, A, Marshall, S & Bachrach, LK 2010, 'Recovery of bone mineral density in adolescents following the use of depot medroxyprogesterone acetate contraceptive injections', Contraception, vol. 81, no. 4, pp. 281-291. https://doi.org/10.1016/j.contraception.2009.11.003
Harel, Zeev ; Johnson, Christine Cole ; Gold, Melanie A. ; Cromer, Barbara ; Peterson, Edward ; Burkman, Ronald ; Stager, Margaret ; Brown, Robert ; Bruner, Ann ; Coupey, Susan M. ; Hertweck, Paige ; Bone, Henry ; Wolter, Kevin ; Nelson, Anita ; Marshall, Sharon ; Bachrach, Laura K. / Recovery of bone mineral density in adolescents following the use of depot medroxyprogesterone acetate contraceptive injections. In: Contraception. 2010 ; Vol. 81, No. 4. pp. 281-291.
@article{bc225c0d979a465588347a8bf3cc1477,
title = "Recovery of bone mineral density in adolescents following the use of depot medroxyprogesterone acetate contraceptive injections",
abstract = "Background: Depot medroxyprogesterone acetate (DMPA) is a highly effective progestin-only contraceptive that is widely used by adolescents. We investigated bone mineral density (BMD) changes in female adolescents during and following use of this method. Study Design: A multicenter, prospective, non-randomized observational study in 98 healthy female adolescents aged 12-18 years who initiated DMPA intramuscular injections for contraception and provided BMD data for up to 240 weeks while receiving DMPA and for up to 300 weeks after DMPA cessation. BMD at the lumbar spine (LS), total hip (TH) and femoral neck (FN) was assessed by dual-energy X-ray absorptiometry. A mixed model analysis of variance was used to examine BMD changes. Results: At the time of their final DMPA injection, participants had mean BMD declines from baseline of 2.7{\%} (LS), 4.1{\%} (TH) and 3.9{\%} (FN) (p<.001 at all three sites). Within 60 weeks of discontinuation of DMPA, mean LS BMD had returned to baseline levels, and 240 weeks after DMPA discontinuation, the mean LS BMD was 4.7{\%} above baseline. Mean TH and FN BMD values recovered to baseline values more slowly: 240 weeks and 180 weeks, respectively, after the last DMPA injection. Conclusions: BMD loss in female adolescents receiving DMPA for contraception is substantially or fully reversible in most girls following discontinuation of DMPA, with faster recovery at the LS than at the hip.",
keywords = "Adolescents, Bone density, Contraceptive agents, Depot medroxyprogesterone acetate",
author = "Zeev Harel and Johnson, {Christine Cole} and Gold, {Melanie A.} and Barbara Cromer and Edward Peterson and Ronald Burkman and Margaret Stager and Robert Brown and Ann Bruner and Coupey, {Susan M.} and Paige Hertweck and Henry Bone and Kevin Wolter and Anita Nelson and Sharon Marshall and Bachrach, {Laura K.}",
year = "2010",
month = "4",
doi = "10.1016/j.contraception.2009.11.003",
language = "English (US)",
volume = "81",
pages = "281--291",
journal = "Contraception",
issn = "0010-7824",
publisher = "Elsevier USA",
number = "4",

}

TY - JOUR

T1 - Recovery of bone mineral density in adolescents following the use of depot medroxyprogesterone acetate contraceptive injections

AU - Harel, Zeev

AU - Johnson, Christine Cole

AU - Gold, Melanie A.

AU - Cromer, Barbara

AU - Peterson, Edward

AU - Burkman, Ronald

AU - Stager, Margaret

AU - Brown, Robert

AU - Bruner, Ann

AU - Coupey, Susan M.

AU - Hertweck, Paige

AU - Bone, Henry

AU - Wolter, Kevin

AU - Nelson, Anita

AU - Marshall, Sharon

AU - Bachrach, Laura K.

PY - 2010/4

Y1 - 2010/4

N2 - Background: Depot medroxyprogesterone acetate (DMPA) is a highly effective progestin-only contraceptive that is widely used by adolescents. We investigated bone mineral density (BMD) changes in female adolescents during and following use of this method. Study Design: A multicenter, prospective, non-randomized observational study in 98 healthy female adolescents aged 12-18 years who initiated DMPA intramuscular injections for contraception and provided BMD data for up to 240 weeks while receiving DMPA and for up to 300 weeks after DMPA cessation. BMD at the lumbar spine (LS), total hip (TH) and femoral neck (FN) was assessed by dual-energy X-ray absorptiometry. A mixed model analysis of variance was used to examine BMD changes. Results: At the time of their final DMPA injection, participants had mean BMD declines from baseline of 2.7% (LS), 4.1% (TH) and 3.9% (FN) (p<.001 at all three sites). Within 60 weeks of discontinuation of DMPA, mean LS BMD had returned to baseline levels, and 240 weeks after DMPA discontinuation, the mean LS BMD was 4.7% above baseline. Mean TH and FN BMD values recovered to baseline values more slowly: 240 weeks and 180 weeks, respectively, after the last DMPA injection. Conclusions: BMD loss in female adolescents receiving DMPA for contraception is substantially or fully reversible in most girls following discontinuation of DMPA, with faster recovery at the LS than at the hip.

AB - Background: Depot medroxyprogesterone acetate (DMPA) is a highly effective progestin-only contraceptive that is widely used by adolescents. We investigated bone mineral density (BMD) changes in female adolescents during and following use of this method. Study Design: A multicenter, prospective, non-randomized observational study in 98 healthy female adolescents aged 12-18 years who initiated DMPA intramuscular injections for contraception and provided BMD data for up to 240 weeks while receiving DMPA and for up to 300 weeks after DMPA cessation. BMD at the lumbar spine (LS), total hip (TH) and femoral neck (FN) was assessed by dual-energy X-ray absorptiometry. A mixed model analysis of variance was used to examine BMD changes. Results: At the time of their final DMPA injection, participants had mean BMD declines from baseline of 2.7% (LS), 4.1% (TH) and 3.9% (FN) (p<.001 at all three sites). Within 60 weeks of discontinuation of DMPA, mean LS BMD had returned to baseline levels, and 240 weeks after DMPA discontinuation, the mean LS BMD was 4.7% above baseline. Mean TH and FN BMD values recovered to baseline values more slowly: 240 weeks and 180 weeks, respectively, after the last DMPA injection. Conclusions: BMD loss in female adolescents receiving DMPA for contraception is substantially or fully reversible in most girls following discontinuation of DMPA, with faster recovery at the LS than at the hip.

KW - Adolescents

KW - Bone density

KW - Contraceptive agents

KW - Depot medroxyprogesterone acetate

UR - http://www.scopus.com/inward/record.url?scp=77949319587&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=77949319587&partnerID=8YFLogxK

U2 - 10.1016/j.contraception.2009.11.003

DO - 10.1016/j.contraception.2009.11.003

M3 - Article

C2 - 20227543

AN - SCOPUS:77949319587

VL - 81

SP - 281

EP - 291

JO - Contraception

JF - Contraception

SN - 0010-7824

IS - 4

ER -