Bone mineral density changes during use of progestin-only contraceptives: a rapid review of recent evidence

Objective

The purpose of this paper is to consolidate existing evidence and identify knowledge and research gaps on the bone health effects of progestin-only oral contraception, injectables, hormonal intrauterine devices, and implants. implementation.

Data sources

We searched PubMed, CINAHL, Web of Science, and The Cochrane Library for conference abstracts, original research articles, systematic reviews, and meta-analyses published between 05 May 2012 and 31 August 2023.

Study eligibility criteria

We limited results to any study design published as a conference abstract, original research study, meta-analysis, or systematic review in English-language peer-reviewed journals.

Study appraisal and synthesis methods

Two independent reviewers screened item titles. One reviewer read all abstracts and full papers, and a second reviewer confirmed alignment with a 5% sample of each. One reviewer extracted relevant information into Excel with a 5% sample review by another research team member. We reviewed the references for all included items and screened potentially relevant items in the same manner as described above. Subject matter experts contributed additional items. We assessed items using the Mixed Methods Appraisal tool.

Results

The search strategy yielded 32 items, most of which explored the use of intra-muscular depot medroxyprogesterone acetate 150mg. We found a clear association between any use of depot medroxyprogesterone acetate and bone mineral density loss. This negative effect seems to be more common among younger women and women on antiretrovirals. There is, however, evidence to suggest that bone loss can be restored after depot medroxyprogesterone acetate discontinuation. Hormonal intrauterine device and implant users do not seem to experience bone mineral density loss.

Conclusions

While there is a clear association between bone mineral density loss and depot medroxyprogesterone acetate injectable use, treatment during contraceptive use and bone health restoration following discontinuation are not adequately researched. In this review, we provide evidence that bone health can be partially or completely restored after depot medroxyprogesterone acetate discontinuation, identify opportunities to learn more about depot medroxyprogesterone acetate injectables and bone health during and after use, and find gaps in knowledge on potential associations between bone health and other progestin-only contraceptives.