Abstract
The clinical research to date on the effects of 3 types of hormonal contraceptives, i.e. depot medroxyprogesterone acetate (‘Depo-Provera’), levonorgestrel subdermal implants (‘Norplant’), and oral contraceptives, on bone mineral density in premenopausal women is reviewed.
The large variance in results across studies for each method is in part due to differences in research design, techniques for measuring bone mineral density, age of the study participants and type of oral contraceptive preparation.
However, the balance of the evidence leans toward a positive effect of oral contraceptives on bone mineral density in women of all age. On the other hand, few observations have yet been published on the effects of the new progestin oral contraceptives on bone mineral density.
The few extant data suggest a positive impact of levonorgestrel subdermal implants on bone mineral density in women of all ages. Although the findings are preliminary, it appears that depot medroxyprogesterone acetate may exert a negative effect on bone mineral density. More specifically, caution should be exercised in prescribing long term depot medroxyprogesterone acetate (e.g. >5 years) especially in young adolescents (e.g. <16 years old) who may not have yet reached peak bone mass.
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References
Speroff L, Glass RH, Kase NG, editors. Clinical gynecologic endocrinology and infertility. 5th ed. Baltimore (MD): William and Wilkins, 1994
Consensus Panel. Osteoporosis. JAMA 1984; 252: 799–802
Delmas PD, Bjarnason NH, Mitlak BH, et al. Effects of raloxifene on bone mineral density, serum cholesterol concentrations, and uterine endometrium in postmenopausal women. N Engl J Med 1997; 337(23): 1641–7
Recker RR, Davies M, Hinders SM. Bone gain in young adult women. JAMA 1992; 268: 2403–8
Mazess RB, Barden HS. Bone mineral density in premenopausal women: effects of age, dietary intake, physical activity, smoking, and birth control pills. Am J Clin Nutr 1991; 53: 132–42
Kreipe DR, Forbes GB. Osteoporosis: a ‘new morbidity’ for dieting female adolescents? Pediatrics 1990; 86: 478–80
Matkovic V, Jelic T, Wardlaw GM, et al. Timing of peak bone mass in Caucasian females and its implication for the prevention of osteoporosis: inference from a cross-sectional model. J Clin Invest 1994; 93: 799–808
Hergenroeder AC. Bone mineralization, hypothalmic amenorrhea, and sex steroid therapy in female adolescents and young adults. J Pediatr 1995; 126: 683–9
Theinz G, Buchs B, Nizzolo R, et al. Longitudinal monitoring of bone mass accumulation in healthy adolescents: evidence for a marked reduction after 16 years of age at the levels of lumbar spine and femoral neck in female subjects. J Clin Endocrinol Metab 1992; 75: 1060–5
Teegarden D, Proulx WR, Martin BR, et al. Peak bone mass in young women. J Bone Miner Res 1995; 10: 711–5
Dhuper S, Warren M P, Brooks-Gunn J, et al. Effects of hormonal status on bone mineral density in adolescent girls. J Clin Endocrinol Metab 1990; 71: 1083–8
Grecu EO, Weinshelbaum A, Simmons R. Effective therapy of glucocorticoid-induced osteoporosis with medroxyprogesterone acetate. Calcif Tissue Int 1990; 46: 294–9
Cundy T, Evans M, Roberts, et al. Bone mineral density in women receiving depot medroxyprogesterone acetate for contraception. BMJ 1991; 303: 13–9
Cromer BA, McArdle Blair J, Mahan JD, et al. A prospective comparison of bone mineral density in adolescent girls on depot medroxyprogesterone acetate (Depo-Provera), levonorgestrel (Norplant), or oral contraceptives. J Pediatr 1996; 129: 671–6
Naessen T, Olson SE, Gudmundson J. Differential effects on bone mineral density of progestogen-only methods for contraception in premenopausal women. Contraception 1995; 52: 35–9
Scholes D, LaCroix AZ, Ichikawa L, et al. Depo-medroxyprogesterone acetate exposure and bone mineral density in young women. Annual Meeting of the American Society for Bone and Mineral Research: 1996 Sep 7–11; Seattle
Taneepanichskul S, Intaraprasert S, Theppisai U, et al. Bone mineral density during long-term treatment with Norplant® implants and depot medroxyprogesterone acetate: a cross-sectional study of Thai women. Contraception 1997; 56: 153–5
Taneepanichskul S, Intaraprasert S, Theppisai U, et al. Bone mineral density in long-term depot medroxyprogesterone acetate acceptors. Contraception 1997; 56: 1–3
Mandel FP, Davidson BJ, Erlik Y, et al. Effects of progestins on bone metabolism in postmenopausal women. J Reprod Med 1982; 27(8): 511–4
Gallagher JC, Kable WT, Goldgar D. Effect of progestin therapy on cortical and trabecular bone: comparison with estrogen. Am J Med 1991; 90: 171–8
Caird LE, Reid-Thomas V, Hannan WJ, et al. Oral progestogen-only contraception may protect against loss of bone mass in breast-feeding women. Clin Endocrinol 1994; 41: 739–45
Brache V, Alvarez-Sanchez F, Faundes A, et al. Ovarian endocrine function through five years of continuous treatment with Norplant® subdermal contraceptive implants. Contraception 1990; 41(2): 169–77
Goldsmith NJ, Johnston JO. Bone mineral density: effects of oral contraceptives, pregnancy, and lactation. Am J Bone Joint Surg 1975; 57-A(5): 657–68
Shargil A. Hormone replacement therapy in perimenopausal women with a triphasic contraceptive compound: a three-year prospective study. Int J Fertil 1985: 30: 15–28
Lindsay R, Tohme J, Kanders B. The effect of oral contraceptive use on vertebral bone mass in pre- and post-menopausal women. Contraception 1986; 34: 333–40
Hreshchyshyn MM, Hopkins A, Zylstra S, et al. Associations of parity, breast-feeding, and birth control pills with lumbar spine and femoral neck bone densities. Am J Obstet Gynecol 1988; 159: 318–22
Lloyd T, Buchanan JR, Ursino GR, et al. Long-term oral contraceptive use does not affect trabecular bone density. Am J Obstet Gynecol 1989; 160: 402–4
Kleerekoper M, Brienza RS, Schultz LR, et al. Oral contraceptive use may protect against low bone mass. Arch Intern Med 1991; 151: 1971–6
Rodin A, Chapman M, Ignac Fogelman. Bone density in users of combined oral contraception: preliminary reports of a pilot study. Br J Fam Plann 1991; 16: 125–9
Kritz-Silverstein D, Barrett-Connor E. Bone mineral density in post menopausal women as determined by prior oral contraceptive use. Am J Public Health 1993; 83: 100–2
Szarewski An, Hollingworth B, Guillebaud J. Depot medroxyprogesterone acetate and osteoporosis: monitor serum oestradiol concentration in users [letter]. BMJ 1994; 308: 717
Mehta S. Bone loss, contraception and lactation. Acta Obstet Gynecol Scand 1993; 72: 148–56
Cundy T, Cornish J, Evans MC, et al. Recovery of bone mineral density in women who stop using medroxyprogesterone acetate. BMJ 1993; 308: 247–8
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Cromer, B.A. Effects of Hormonal Contraceptives on Bone Mineral Density. Drug-Safety 20, 213–222 (1999). https://doi.org/10.2165/00002018-199920030-00002
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DOI: https://doi.org/10.2165/00002018-199920030-00002