We read with interest the recent review by the AAP's Committee on Adolescents entitled “Contraception and the Adolescent.”1 “Reversible osteopenia” was mentioned as a possible adverse effect of depot medroxyprogesterone acetate (DMPA, marketed as Depo Provera, Pharmacia & Upjohn, Kalamazoo, MI). As clinicians and researchers, we are aware that concern about the effects of DMPA on bone mineral has led some practitioners to avoid DMPA use in adolescents. We believe it would be helpful to review the data and controversies linking DMPA and osteopenia.

DMPA works as a contraceptive by inhibiting pituitary gonadotropin secretion, which suppresses both ovulation and ovarian estrogen production. Concern about the skeletal effects of reduced serum estrogen has prompted studies of bone mineral. Several cross-sectional surveys have found lower bone density in long-term DMPA users than nonusers; the effects were most marked in younger women.2–4 Two small prospective studies in teenage girls (average age...

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