Protecting Bone Health in Young Women Using Depot Medroxyprogesterone

My patients are relatively young women. Over the past year, I started ordering dual energy x-ray absorptiometry (DEXA) scans for patients who had been receiving depot medroxyprogesterone injections for more than 2 years. Most of these women either were not aware of the need for calcium supplementation in conjunction with depot medroxyprogesterone or had not been compliant with it. DEXA scan results have confirmed either osteopenia or osteoporosis in at least 4 or 5 patients (aged 25 years or younger). The literature I have seen on bisphosphonate therapy discusses it only in the context of osteoporosis in postmenopausal women. What are your recommendations for women in their 20s who have osteoporosis or osteopenia?

- Carla Spikowski, LtCol, USAF NC, WHNP
   Edwards Air Force Base, Calif

At this time, there is no indication for bisphosphonate therapy in young women. Also, I would advise against ordering DEXA scans in healthy young women who are receiving depot medroxyprogesterone because we do not know how to interpret values obtained in this age group. (The Society for Adolescent Medicine plans to issue a position paper on depot medroxyprogesterone and bone mineral density in adolescents sometime this coming summer.) In addition, data are accumulating that show at least partial recovery of bone density after discontinuation of depot medroxyprogesterone. Meanwhile, continue to recommend calcium and vitamin D supplementation and strength training to your patients.

- Barbara Cromer, MD
   Frederick C. Robbins Professor of Child and Adolescent Health
   Case Western Reserve University School of Medicine
   Cleveland