A prospective study of the effects of oral and injectable contraception on bone mineral density

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Abstract
Objective: To compare the effects of different hormonal contraceptives on bone mineral density (BMD) in reproductive age women. Methods: We conducted a prospective, longitudinal study on 100 women aged 18–33 years who initiated use of injectable depot medroxyprogesterone acetate (DMPA), norethindrone-containing oral contraceptives, or desogestrel-containing oral contraceptives to compare their effects on BMD. Bone mineral density was measured by dual energy X-ray absorptiometry at baseline and after 1 year of contraceptive use. Data on other factors that could affect BMD (smoking status, alcohol use, body mass index, exercise habits, and race) were obtained by interview or examination. An analysis of covariance was performed to test for differences in BMD among the three groups after 1 year of contraceptive use, controlling for potential confounding variables. Results: No significant differences were noted in age, race, body mass index, smoking status, alcohol use, exercise habits, or BMD between the three groups at baseline. After 1 year of contraceptive use, DMPA users experienced a 2.5% decrease in BMD, compared with a 2.8% increase among users of norethindrone-containing pills and a 0.9% increase among users of desogestrel-containing pills (P P P = 0.001) and between users of norethindrone- and desogestrel-containing pills (P = 0.04). Conclusions: These data demonstrate that different methods of hormonal contraception have significantly different effects, at least temporarily, on BMD after only 1 year of use.

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