Depot Medroxyprogesterone Acetate and Bone Mineral Density

Graeme J. Dennerstein, Shavi Fernando, Chiu Pin Teo, Alex Gorelik, Beverley Vollenhoven, Ian Fraser, John D. Wark


Background: Previous studies have suggested that depot medroxyprogesterone acetate (DMPA) may result in a reduction in bone mineral density (BMD). This study further explores this relationship. This study was undertaken to assess the association between long-term DMPA use and areal BMD (aBMD) in a uniform manner in a single private specialist practice over two decades.

Methods: Of 1,046 consecutive patients using DMPA in a single Melbourne specialists practice between 1981 and 2013, from 1992 102 were referred for dual-energy X-ray absorptiometry (DXA) scans. Each was matched for age and body mass index with two participants from a reference group of 1,416 healthy female volunteers who underwent DXA scans at the Royal Melbourne Hospital.

Results: A total of 306 participants were included in this study, 102 cases and 204 referents. DMPA users had lower aBMD at first testing (median duration of DMPA use 4.3 years (IQR 2.6 - 6.7 years) compared with the reference group, and lower aBMD persisted in users 2 - 5 years post cessation of DMPA. These differences from the reference group were statistically and potentially clinically significant. There was no evidence of accelerated bone loss at any site in the DMPA users during longitudinal observations on treatment, but the study had limited power to detect such an effect.

Conclusions: DMPA use was associated with aBMD deficits during and after treatment. The findings demonstrate that long-term, controlled, prospective studies with adequate sample size are required to evaluate the potential clinical impact of DMPA use on bone health outcomes.

J Clin Gynecol Obstet. 2018;7(3-4):63-68


Depot medroxyprogesterone acetate; DMPA; Bone mineral density; BMD; Depo-Provera

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