Bone biochemical markers in adolescent girls using either depot medroxyprogesterone acetate or an oral contraceptive

J Pediatr Adolesc Gynecol. 2004 Dec;17(6):373-7. doi: 10.1016/j.jpag.2004.09.013.


Study objective: To examine the relationship between biochemical markers of bone metabolism and hormonal contraception in adolescents.

Design: A prospective, observational design.

Setting: The study was conducted in four adolescent health clinics in a large metropolitan area.

Participants: The study population comprised healthy, postmenarcheal adolescent girls aged 12-18 initiating either medroxyprogesterone acetate (n=53) or an oral contraceptive (OC) containing 20 mug ethinyl estradiol/100 mug levonorgestrel (n=165) and those using no hormonal contraception (n=152).

Interventions: None.

Main outcome measures: Serum bone specific alkaline phosphatase (BSAP), urinary deoxypyridinoline (DPD), and bone mineral density (BMD) at baseline and 12 months.

Results: At 12 month follow-up, serum BSAP levels were significantly higher (P < 0.05) in the control group (40.4 U/L +/- 1.03 SE), than in the DMPA group (35.2 U/L +/- 1.05 SE) and the OC group (35.5 U/L +/- 1.03 SE). There was a trend in urinary DPD levels to be higher (P=0.08) in the control group (9.9 nmol/mmol Cr +/- 1.03 SE) than in the DMPA group (9.1 +/- 1.05 SE) and the OC group (8.9 +/- 1.03 SE). No relationship was found between the biochemical markers and BMD at the lumbar spine or the femoral neck.

Conclusions: Over 12 months, there was evidence of increased bone formation and resorption in the control group when compared to that in the DMPA and OC groups. This finding may indicate a suppression of bone metabolism in girls using DMPA or an OC containing 20 mug ethinyl estradiol/100 mug levonorgestrel.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adolescent
  • Alkaline Phosphatase / blood
  • Amino Acids / urine
  • Biomarkers / metabolism*
  • Bone Density
  • Bone Resorption
  • Bone and Bones / metabolism*
  • Case-Control Studies
  • Contraceptives, Oral*
  • Ethinyl Estradiol
  • Female
  • Follow-Up Studies
  • Humans
  • Levonorgestrel
  • Medroxyprogesterone Acetate*
  • Prospective Studies
  • Time Factors


  • Amino Acids
  • Biomarkers
  • Contraceptives, Oral
  • Ethinyl Estradiol
  • Levonorgestrel
  • deoxypyridinoline
  • Medroxyprogesterone Acetate
  • Alkaline Phosphatase