Elsevier

Obstetrics & Gynecology

Volume 98, Issue 4, October 2001, Pages 576-582
Obstetrics & Gynecology

A prospective, controlled study of the effects of hormonal contraception on bone mineral density

Presented at the Annual Clinical Meeting of Obstetricians and Gynecologists, San Francisco, California, May 22, 2000.
https://doi.org/10.1016/S0029-7844(01)01495-8Get rights and content

Abstract

OBJECTIVE:

To compare the effect of depot medroxyprogesterone acetate (DMPA) and two types of oral contraceptives (OC) on bone mineral density (BMD) among women 18–33 years of age with those not using hormonal contraception.

METHODS:

Data from 155 women were analyzed. Depot medroxyprogesterone acetate was administered to 33 women; 63 women who chose oral contraception were randomly assigned to receive either a norethindrone-containing pill (n = 28) or a desogestrel-containing pill (n = 35). Fifty-nine women who did not use hormonal contraception served as controls. Lumbar spine BMD was determined using dual-energy x-ray absorptiometry at baseline and after 12 months of contraceptive use. We analyzed method-related percent change in BMD while controlling for body mass index, calcium intake, exercise, and smoking. We had approximately 90% power to detect a 2.5% difference between any two groups.

RESULTS:

Users of DMPA experienced a mean BMD loss of 2.74% over 12 months compared with controls who sustained a 0.37% loss (P = .01). Users of OCs generally demonstrated a gain (2.33% for norethindrone-containing pills, 0.33% for desogestrel-containing pills), which was different from controls among users of norethindrone-containing pills (P = .01), but not among users of desogestrel-containing pills (P = .99). Observed changes in BMD among DMPA users differed from women who used either type of pill (P < .002).

CONCLUSION:

Depot medroxyprogesterone acetate has an adverse effect on BMD, in comparison with OCs or nonhormonal methods, when used for 12 months. Results must be interpreted cautiously until it is determined whether these effects endure or are reversible.

Section snippets

Materials and methods

All women recruited between May 16, 1996, and January 20, 1999, who had undergone a baseline bone scan as part of a larger contraceptive study, were eligible to participate. Subjects were between 18 and 33 years of age and white, black, Asian, or Hispanic. Because of the funding source (Department of Defense), all women were required to meet minimal criteria for entry into the Armed Forces (graduated high school or had GED, no felony arrests, within 36% of ideal body weight for height, and free

Results

A total of 275 women who met all inclusion criteria were enrolled in the study. Of these, 96 chose injectable contraception and were administered DMPA, whereas 179 women elected to initiate oral contraception and were randomly assigned to receive either norethindrone-containing (n = 87) or desogestrel-containing (n = 92) pills. Thirty-nine percent (107 of 275) of women discontinued their hormonal method before their 12-month visit. Of the 168 women who continued their method, 31 failed to

Discussion

We observed that use of DMPA for 12 months has an adverse effect on BMD, compared with OCs or nonhormonal methods. On average, women who used DMPA experienced approximately a 2.7% loss in BMD compared with a 0.37% loss in those not using hormonal contraception and small gains among OC users of 0.33% and 2.33%, respectively, for users of desogestrel- and norethindrone-containing pills. The mechanism of the effect of DMPA on BMD is unknown. However, studies have shown that DMPA users have

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This study was supported by the US Army Medical Research and Material Command under contract No. DAMD17-96-C-6113, and by the National Osteoporosis Foundation.

The views, opinions, and/or findings contained in this report are those of the authors and should not be construed as an official Department of the Army position, policy, or decision unless so designated by other documentation. The investigators adhered to the policies regarding the protection of human subjects as described by 45 CFR 46 and 32 CFR 219 (Protection of Human Subjects).

1

Dr. Rickert is currently at the Department of Pediatrics, The Mount Sinai School of Medicine, New York, New York; and Dr. Thomas is in private practice in Oakland, California.

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