Depot medroxyprogesterone acetate (DMPA) is a highly effective injectable contraceptive that affords privacy and has a convenient dose schedule of four times per year, making it appealing to many users, especially adolescents. Although the use of DMPA is associated with loss of bone mineral density (BMD), current longitudinal and cross-sectional evidence suggests that recovery of BMD occurs after discontinuation of DMPA. No high-quality data answer the important clinical question of whether DMPA affects fracture risk in adolescents or adults later in life. The effect of DMPA on BMD and potential fracture risk should not prevent practitioners from prescribing DMPA or continuing use beyond 2 years. The potential health risks associated with the bone effects of DMPA must be balanced against a woman's likelihood of pregnancy using other methods or no method, and the known negative health and social consequences associated with unintended pregnancy, particularly among adolescents. Health care providers should inform women and adolescents considering initiating DMPA or continuing to use the method about the benefits and the risks of DMPA and should discuss the U.S. Food and Drug Administration "black box" warning and use clinical judgment to assess appropriateness of use.