Skip to main content
SpringerLink
Log in

Association between depot medroxyprogesterone acetate (DMPA), physical activity and bone health

  • Original Article
  • Published:
Journal of Bone and Mineral Metabolism Aims and scope Submit manuscript

Abstract

Physical activity has been advocated for women in the hope of offsetting progestin-only contraceptive-related loss in bone mineral density. There is limited evidence for the beneficial effect of physical activity on bone health of hypo-oestrogenic premenopausal women. The aim of this cross-sectional study was to examine the relationship between physical activity and bone health [as measured by quantitative ultrasound (QUS)] of depot-medroxyprogesterone acetate (DMPA) users, and to investigate whether QUS measurements of DMPA users and non-users differed according to physical activity. Bone health of 48 DMPA users and 48 age-matched controls (22.83 ± 3.2 years) was assessed using calcaneal broadband ultrasound attenuation (BUA). Participants were categorised into low and high levels of physical activity based on their exposure to bone-loading exercise. Analysis of covariance was conducted to determine if QUS measurements of DMPA users and non-DMPA users differed within levels of bone-loading physical activity after controlling for body mass index. The duration of DMPA use ranged from 6 to 132 months. Participants’ reference bone-loading exposure time averaged 3.3 ± 1.8 years. Data analysis revealed that DMPA users had significantly lower BUA by 6.54 dB/MHz (t (95) = −2.411, p = 0.018) compared to non-users of DMPA. Concurrently high levels of physical activity and DMPA use led to 1.996 dB/MHz decreases in BUA. A cycle of prolonged DMPA use and concurrent engagement in high levels of physical activity appears detrimental to bone health. It is suggested that the lack of oestrogen may counteract the effects of physical activity by inhibiting bone formation in response to mechanical bone-loading.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Lader D, Hopkins G (2008) Contraception and sexual health: a report on research using the National Statistics Omnibus Survey produced on behalf of the NHS information centre for health and social care. Office for National Statistics, Omnibus Survey Report 2008; No. 37, Newport, UK

  2. WHO, Usaid, FHI (2009) Strategic considerations for strengthening the linkages between family planning and HIV/AIDS policies, programs, and services. WHO, Geneva

    Google Scholar 

  3. Inc Pfizer (2004) Depo-Provera: physician information. Pfizer Inc., New York

    Google Scholar 

  4. Mishell DR Jr (1996) Pharmacokinetics of depot medroxyprogesterone acetate contraception. J Reprod Med 41:381–390

    CAS  PubMed  Google Scholar 

  5. Gbolade B, Ellis S, Murby B, Randall S, Kirkman R (1998) Bone density in long-term users of depot medroxyprogesterone acetate. Br J Obstet Gynecol 105:790–794

    Article  CAS  Google Scholar 

  6. Oritz A, Hiroi F, Stanczyk FZ, Goebelsmann U, Mishell DR (1977) Serum medroxyprogesterone acetate MPA concentration and ovarian function following intramuscular injection of Depo-MPA. JCEM 44:32–38

    Google Scholar 

  7. Gbolade BA (2002) Depo-Provera and bone density. J Fam Plann Reprod Health Care 28:7–11

    Article  PubMed  Google Scholar 

  8. Bachrach LK, Cundy T, Ott SM (2000) Depot medroxyprogesterone acetate in teens: a risk for bone health? Pediatrics 106:1137–1138

    Article  CAS  PubMed  Google Scholar 

  9. Cromer BA (2003) Bone mineral density in adolescent and young women on injectable or oral contraception. Curr Opin Obstet Gynecol 15:353–357

    Article  PubMed  Google Scholar 

  10. Davis AJ (1996) Use of depot medroxyprogesterone acetate contraception in adolescents. J Reprod Med 41(Suppl):407–413

    CAS  PubMed  Google Scholar 

  11. Guilbert ER, Brown JP, Kaunitz AM, Wagner MS, Bérubé J, Charbonneau L, Francoeur D, Gilbert A, Gilbert F, Roy G, Senikas V, Jacob R, Morin R (2009) The use of depot-medroxyprogesterone acetate in contraception and its potential impact on skeletal health. Contraception 79:167–177 Epub 2009 Jan 15

    Article  CAS  PubMed  Google Scholar 

  12. Kass-Wolff JH (2001) Bone loss in adolescents using Depo-Provera. J Soc Pediatr Nurs 6:21–31

    Article  CAS  PubMed  Google Scholar 

  13. Westhoff C (2003) Depot-medroxyprogesterone acetate injection (Depo-Provera®): a highly effective contraceptive option with proven long-term safety. Contraception 68:75–87

    Article  CAS  PubMed  Google Scholar 

  14. d’Arcanques D (2006) WHO statement on hormonal contraception and bone health. Contraception 73:443–444

    Article  Google Scholar 

  15. Cromer BA, Scholes D, Berenson T, Cundy A, Clark MK, Kaunitz AM (2006) Depot medroxyprogesterone acetate and bone mineral density in adolescents—the black box warning: a position paper of the Society for Adolescent Medicine Journal of Adolescent Health. JAH 39:296–301. doi:10.1016/j.jadohealth.2006.03.011

    Google Scholar 

  16. O’Sullivan I, Keyse L, Park N, Diaper A, Short S (2005) Contraception and sexual health 2004/05. ISBN: 1857746120

  17. Black (2006) Canadian contraception consensus—update on depot medroxyprogesterone acetate (DMPA). J Obstet Gynaecol 28:305–313

    Google Scholar 

  18. Hertzler AA, Frary RB (1994) A dietary calcium rapid assessment method (RAM). Top Clin Nutr 9:76–85

    Article  Google Scholar 

  19. Dolan SH, Williams DP, Ainsworth BE, Shaw JM (2006) Development and reproducibility of the bone loading history questionnaire. Med Sci Sports Exerc 38:1121–1131. doi:10.1249/01.mss.0000222841.96885.a8

    Article  PubMed  Google Scholar 

  20. Nicholson PHF, Alkalay R (2007) Quantitative ultrasound predicts bone mineral density and failure load in human lumbar vertebrae. Clin Biomech 22:623–629

    Article  CAS  Google Scholar 

  21. Cheng S, Njeh CF, Fan B, Cheng X, Hans D, Wang L, Fuerst T, Genant HK (2002) Influence of region of interest and bone size on calcaneal BMD: implications for the accuracy of quantitative ultrasound assessments at the calcaneus. Br J Radiol 75(889):59–68

    CAS  PubMed  Google Scholar 

  22. Hartard M, Bottermann P, Bartenstein P, Jeschke D, Schwaiger M (1997) Effects on bone mineral density of low-dosed oral contraceptives compared to and combined with physical activity. Contraception 55:87–90

    Article  CAS  PubMed  Google Scholar 

  23. Weaver CM, Teegarden D, Lyle RM, McCabe GP, McCabe LD, Proulx W, Kern M, Sedlock D, Anderson DD, Hillberry BM, Peacock M, Johnston CC (2001) Impact of exercise on bone health and contraindication of oral contraceptive use in young women. Med Sci Sports Exerc 33:873–880

    Article  CAS  PubMed  Google Scholar 

  24. Zaman G, Cheng MZ, Jessop HL, White R, Lanyon LE (2000) Mechanical strain activates oestrogen response elements in bone cells. Bone 27:233–239

    Article  CAS  PubMed  Google Scholar 

  25. Cundy T, Evans M, Roberts H, Wattie D, Ames R, Reid IR (1991) Bone density in women receiving depot medroxyprogesterone acetate for contraception. BMJ 303:13–16

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  26. Scholes D, Lacroix AZ, Ott SM, Ichikawa LE, Barlow WE (1999) Bone mineral density in women using depot medroxyprogesterone acetate for contraception. Obstet Gynecol 93:233–238

    Article  CAS  PubMed  Google Scholar 

  27. Cromer BA, Stager M, Bonny A, Lazebnik R, Rome E, Ziegler J, Debanne SM (2004) Depot medroxyprogesterone acetate, oral contraceptives and bone mineral density in a cohort of adolescent girls. JAH 35:434–441. doi:10.1016/j.jadohealth.2004.07.005

    Google Scholar 

  28. Rosenburg L, Zhang Y, Constant D, Cooper D, Kalla AA, Micklesfield L, Hoffman M (2007) Bone status after cessation of use of injectable progestin contraceptives. Contraception 76:425–431

    Article  Google Scholar 

  29. Lappe JM, Stegman MR, Recker RR (2001) The impact of lifestyle factors on stress fractures in female Army recruits. Osteoporos Int 12:35–42

    Article  CAS  PubMed  Google Scholar 

  30. Madsen OR, Sørensen OH, Egsmose C (2002) Bone quality and bone mass as assessed by quantitative ultrasound and dual energy X ray absorptiometry in women with rheumatoid arthritis: relationship with quadriceps strength. Ann Rheum Dis 61:325–329. doi:10.1136/ard.61.4.325

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  31. Gluer CC (1999) Monitoring skeletal changes by radiological techniques. JBMR 14:1952–1962

    Article  CAS  Google Scholar 

  32. Kaunitz AM, Rosenfield A (1993) Injectable contraception with depot medroxyprogesterone acetate. Drug 45:854–865

    Article  Google Scholar 

  33. Petitti DB, Piaggio G, Mehta S, Cravioto MC, Meirik O (2000) Steroid hormone contraception and bone mineral density: a cross-sectional study in an international population. The WHO Study of Hormonal Contraception and Bone Health. Obstet Gynecol 95:736–744

    Article  CAS  PubMed  Google Scholar 

  34. Albertazzi P, Bottazzi M, Steel SA (2006) Bone mineral density and depot medroxyprogesterone acetate. Contraception 73:577–583

    Article  CAS  PubMed  Google Scholar 

  35. Shaarawy M, El-Mallah SY, Seoudi S, Hassan M, Mohsen IA (2006) Effects of the long-term use of depot medroxyprogesterone acetate as hormonal contraceptive on bone mineral density and biochemical markers of bone remodelling. Contraception 74:297–302

    Article  CAS  PubMed  Google Scholar 

  36. Tang OS, Tang G, Yip P, Li B, Fan S (1999) Long-term depot medroxyprogesterone acetate and bone mineral density. Contraception 59:25–29

    Article  CAS  PubMed  Google Scholar 

  37. Cundy T, Cornish J, Roberts H, Elder H, Reid IR (1999) Spinal bone density in women using depot medroxyprogesterone acetate contraception. Obstet Gynecol 92:569–573

    Article  Google Scholar 

  38. Walsh JS, Eastell R, Peel NF (2008) Effects of depot medroxyprogesterone acetate on bone density and bone metabolism before and after peak bone mass: a case-control study. J Clin Endocrinol Metab 93:1317–1323. http://jcem.endojournals.org/content/93/4/1317.full.pdf+html. Accessed 29 May 2012

    Google Scholar 

  39. Clark MK, Sowers M, Levy B, Nichols S (2006) Bone mineral density loss and recovery during 48 months in first-time users of depot medroxyprogesterone acetate. Fertil Steril 86:1466–1474

    Article  CAS  PubMed  Google Scholar 

  40. Office for National Statistics (2007) Contraception and sexual health. Her Majesty’s Stationary Office, Norwich

    Google Scholar 

Download references

Acknowledgments

The authors would like to acknowledge the invaluable support provided by Dr. Srinivas Namratha (Associate Specialist Contraception and Sexual Health) and the Contraception and Sexual Health team from the Stoke-on-Trent NHS Primary Care Trust during the participant recruitment phase of this Project.

Conflict of interest

All authors have no conflict of interest.

Author information

Authors and Affiliations

  1. School of Psychology, Sport and Exercise, Faculty of Health Sciences, Staffordshire University, Leek Road, Stoke-on-Trent, ST4 2DF, UK

    Opeyemi O. Babatunde & Jacky J. Forsyth

Authors
  1. Opeyemi O. Babatunde
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jacky J. Forsyth
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Opeyemi O. Babatunde.

About this article

Cite this article

Babatunde, O.O., Forsyth, J.J. Association between depot medroxyprogesterone acetate (DMPA), physical activity and bone health. J Bone Miner Metab 32, 305–311 (2014). https://doi.org/10.1007/s00774-013-0497-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00774-013-0497-y

Keywords

Search

Navigation