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

Overview

Journal Obstet Gynecol

Specialty Gynecology & Obstetrics

Date 2008 Oct 2

PMID 18827121

Citations 35

Authors

Abbey B Berenson

Mahbubu Rahman

Carmen Radecki Breitkopf

Lian X Bi

Affiliations

Soon will be listed here.

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, African-American, and Hispanic women using oral contraceptives (OCPs), depot medroxyprogesterone acetate (DMPA), or nonhormonal contraceptives, 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 did nonhormonal contraceptive users (-3.7% and -0.5% compared with +1.9% at lumbar spine, and -5.2% and -1.3% compared with +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% compared with 3.2%, P=.006) and femoral neck (6.0% compared with 4.2%, P=.001) than those aged 25-33 years. After DMPA discontinuation, women who selected nonhormonal contraceptives gained bone mineral density (+4.9% at spine, +3.2% at femoral neck), whereas those who selected OCP recovered spinal (+2.3%) but not femoral neck bone mineral density (-0.7%).

Conclusion: Use of very-low-dose OCPs may result in a small amount of bone loss. Use of DMPA 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.

Citing Articles

U.S. Medical Eligibility Criteria for Contraceptive Use, 2024.

Nguyen A, Curtis K, Tepper N, Kortsmit K, Brittain A, Snyder E MMWR Recomm Rep. 2024; 73(4):1-126.

PMID: 39106314 PMC: 11315372. DOI: 10.15585/mmwr.rr7304a1.

Horizons in Endometriosis: Proceedings of the Montreux Reproductive Summit, 14-15 July 2023.

Vallee A, Saridogan E, Petraglia F, Keckstein J, Polyzos N, Wyns C Facts Views Vis Obgyn. 2024; 16(16 Suppl 1):1-32.

PMID: 38603778 PMC: 11317919. DOI: 10.52054/FVVO.16.s1.011.

Hormonal and non-hormonal oral contraceptives given long-term to pubertal rats differently affect bone mass, quality and metabolism.

Porwal K, Sharma S, Kumar S, Tomar M, Sadhukhan S, Rajput S Front Endocrinol (Lausanne). 2023; 14:1233613.

PMID: 37664835 PMC: 10470083. DOI: 10.3389/fendo.2023.1233613.

Comparison of thromboembolism outcomes in patients with sickle cell disease prescribed hormonal contraception.

Bala N, Stanek J, Vesely S, Cronin R, Creary S, Roe A Blood Adv. 2023; 7(20):6140-6150.

PMID: 37585480 PMC: 10582388. DOI: 10.1182/bloodadvances.2023010204.

Bone impact after two years of low-dose oral contraceptive use during adolescence.

Orsolini L, Goldberg T, Caldeirao T, Cristiane da Silva C, Rizzo A, Biason T PLoS One. 2023; 18(6):e0285885.

PMID: 37289781 PMC: 10249826. DOI: 10.1371/journal.pone.0285885.

References

Scholes D, LaCroix A, Ichikawa L, Barlow W, Ott S . Injectable hormone contraception and bone density: results from a prospective study. Epidemiology. 2002; 13(5):581-7. DOI: 10.1097/00001648-200209000-00015. View

Cromer B, Bonny A, Stager M, Lazebnik R, Rome E, Ziegler J . Bone mineral density in adolescent females using injectable or oral contraceptives: a 24-month prospective study. Fertil Steril. 2008; 90(6):2060-7. PMC: 2652861. DOI: 10.1016/j.fertnstert.2007.10.070. View

Endrikat J, Mih E, Dusterberg B, Land K, Gerlinger C, Schmidt W . A 3-year double-blind, randomized, controlled study on the influence of two oral contraceptives containing either 20 microg or 30 microg ethinylestradiol in combination with levonorgestrel on bone mineral density. Contraception. 2004; 69(3):179-87. DOI: 10.1016/j.contraception.2003.10.002. View

Lara-Torre E, Edwards C, Perlman S, Hertweck S . Bone mineral density in adolescent females using depot medroxyprogesterone acetate. J Pediatr Adolesc Gynecol. 2004; 17(1):17-21. DOI: 10.1016/j.jpag.2003.11.017. View

Berenson A, Breitkopf C, Grady J, Rickert V, Thomas A . Effects of hormonal contraception on bone mineral density after 24 months of use. Obstet Gynecol. 2004; 103(5 Pt 1):899-906. DOI: 10.1097/01.AOG.0000117082.49490.d5. View

Katzman D, Bachrach L, Carter D, Marcus R . Clinical and anthropometric correlates of bone mineral acquisition in healthy adolescent girls. J Clin Endocrinol Metab. 1991; 73(6):1332-9. DOI: 10.1210/jcem-73-6-1332. View

Carter D, Bouxsein M, Marcus R . New approaches for interpreting projected bone densitometry data. J Bone Miner Res. 1992; 7(2):137-45. DOI: 10.1002/jbmr.5650070204. View

Mais V, Fruzzetti F, Ajossa S, Paoletti A, Guerriero S, Melis G . Bone metabolism in young women taking a monophasic pill containing 20 mcg ethinylestradiol: a prospective study. Contraception. 1993; 48(5):445-52. DOI: 10.1016/0010-7824(93)90134-s. View

Polatti F, Perotti F, Filippa N, Gallina D, Nappi R . Bone mass and long-term monophasic oral contraceptive treatment in young women. Contraception. 1995; 51(4):221-4. DOI: 10.1016/0010-7824(95)00036-a. View

10.

Marshall D, Johnell O, Wedel H . Meta-analysis of how well measures of bone mineral density predict occurrence of osteoporotic fractures. BMJ. 1996; 312(7041):1254-9. PMC: 2351094. DOI: 10.1136/bmj.312.7041.1254. View

11.

Nguyen T, Sambrook P, Eisman J . Sources of variability in bone mineral density measurements: implications for study design and analysis of bone loss. J Bone Miner Res. 1997; 12(1):124-35. DOI: 10.1359/jbmr.1997.12.1.124. View

12.

Rosenberg M, Waugh M . Oral contraceptive discontinuation: a prospective evaluation of frequency and reasons. Am J Obstet Gynecol. 1998; 179(3 Pt 1):577-82. DOI: 10.1016/s0002-9378(98)70047-x. View

13.

Guthrie J, Ebeling P, Hopper J, Barrett-Connor E, Dennerstein L, Dudley E . A prospective study of bone loss in menopausal Australian-born women. Osteoporos Int. 1998; 8(3):282-90. DOI: 10.1007/s001980050066. View

14.

Scholes D, LaCroix A, Ott S, Ichikawa L, Barlow W . Bone mineral density in women using depot medroxyprogesterone acetate for contraception. Obstet Gynecol. 1999; 93(2):233-8. DOI: 10.1016/s0029-7844(98)00447-5. View

15.

Ravaud P, Reny J, Giraudeau B, Porcher R, Dougados M, Roux C . Individual smallest detectable difference in bone mineral density measurements. J Bone Miner Res. 1999; 14(8):1449-56. DOI: 10.1359/jbmr.1999.14.8.1449. View

16.

Cromer B, Stager M, Bonny A, Lazebnik R, Rome E, Ziegler J . Depot medroxyprogesterone acetate, oral contraceptives and bone mineral density in a cohort of adolescent girls. J Adolesc Health. 2004; 35(6):434-41. DOI: 10.1016/j.jadohealth.2004.07.005. View

17.

Clark M, Sowers M, Nichols S, Levy B . Bone mineral density changes over two years in first-time users of depot medroxyprogesterone acetate. Fertil Steril. 2004; 82(6):1580-6. DOI: 10.1016/j.fertnstert.2004.04.064. View

18.

Scholes D, LaCroix A, Ichikawa L, Barlow W, Ott S . Change in bone mineral density among adolescent women using and discontinuing depot medroxyprogesterone acetate contraception. Arch Pediatr Adolesc Med. 2005; 159(2):139-44. DOI: 10.1001/archpedi.159.2.139. View

19.

Kolle E, Torstveit M, Sundgot-Borgen J . Bone mineral density in Norwegian premenopausal women. Osteoporos Int. 2004; 16(8):914-20. DOI: 10.1007/s00198-004-1783-2. View

20.

Clark M, Sowers M, Levy B, Nichols S . Bone mineral density loss and recovery during 48 months in first-time users of depot medroxyprogesterone acetate. Fertil Steril. 2006; 86(5):1466-74. DOI: 10.1016/j.fertnstert.2006.05.024. View