Medroxyprogesterone Acetate and Bone Density in Adolescents

Women in over 100 countries have used depot medroxyprogesterone acetate (DMPA) for contraception for more than 30 years. The United States Food and Drug Administration (FDA) approved the use of DMPA in 1992. The only published data collected in the U.S. regarding the use of injectable contraception was done in 1995. Women under the age of 24 were the group most likely to rely on this contraceptive method. In the 15-17 age group, 15% used DMPA for contraception. (Alan Guttmacher Institute, 2000).

Use of this long acting injectable contraception is an appealing option for young females because of its effectiveness and convenience. Preliminary data indicates that DMPA may exert a negative effect on bone mineral density (BMD) in the premenopausal female. Only one study has looked at this issue in the adolescent population. The use of DMPA by females is of great concern because the majority of bone mass is accumulated by late adolescence. During this critical period of bone mineralization, the use of DMPA may adversely affect the young female's achievement peak bone mass. Since the majority of bone mass is normally acquired during adolescence, any factor which interferes with this acquisition can be expected to be a risk factor for the development of osteoporosis. Given the global trend of increased life expectancy, osteoporosis is a major public health concern and the use of DMPA may be a contributing factor to its development.

The purpose of this research is to determine if the young female's use of DMPA affects bone remodeling. 60 participants, age 14-21, will be followed at zero, three, six, nine and 12 months. Dual energy x-ray absorbtiometry will be used to obtain BMD at the initial visit and at six-month intervals. Blood samples for cross-linked N-telopeptides, estradiol and dihydroepiandrostendione sulfate (DHEAS) will be obtained prior to initiation of DMPA and every 12 weeks prior to each DMPA injection. Exploratory analysis will be used to examine the overall sample and individual pattern of BMD and biochemical variables. Sign tests will be performed in which individual's measures at 6 and 12 months are compared to their baseline level. Descriptive statistics will be used to describe age, race, socioeconomic status, height, weight, body mass index (BMI), calcium intake, physical activity, tobacco and alcohol use. This information will be obtained during a structured interview.

Final report is available on NTRL: https://ntrl.ntis.gov/NTRL/dashboard/searchResults/titleDetail/PB2014101774.xhtml