Original research article Biopsychosocial variables associated with substantial bone mineral density loss during the use of depot medroxyprogesterone acetate in adolescents: adolescents who lost 5% or more from baseline vs. those who lost less than 5% Zeev Harel a, ⁎ , Kevin Wolter b , Melanie A. Gold c , Barbara Cromer d , Margaret Stager d , Christine Cole Johnson e , Robert Brown f , Ann Bruner g , Susan Coupey h , Paige Hertweck i , Henry Bone j , Ronald Burkman k , Anita Nelson l , Sharon Marshall m , Laura K. Bachrach n a Division of Adolescent Medicine/Hasbro Children's Hospital and Department of Pediatrics/Warren Alpert Medical School of Brown University, Providence, RI 02903, USA b Pfizer Global Research & Development, New London, CT 06320, USA c Division of Student Affairs/University of Pittsburgh Student Health, Service and Division of Adolescent Medicine/Department of Pediatrics/ University of Pittsburgh, Pittsburgh, PA 15213, USA d Division of Adolescent Medicine/MetroHealth Medical Center and Department of Pediatrics/Case Western Reserve University School of Medicine, Cleveland, OH 44109-1998, USA e Department of Biostatistics and Research Epidemiology, Henry Ford Health System, Detroit, MI 48202-3450, USA f Department of Pediatrics, Ohio State University College of Medicine, Columbus, OH 43210, USA g Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA h Division of Adolescent Medicine/Children's Hospital at Montefiore, and Albert Einstein College of Medicine, New York, NY 10467, USA i Department of Obstetrics, Gynecology & Women Health/University of Louisville School of Medicine, Louisville, KY 40202, USA j Michigan Bone and Mineral Clinic, Detroit, MI 48236, USA k Division of General Obstetrics and Gynecology, Department of Obstetrics and Gynecology, Baystate Medical Center, Springfield, MA 01199, USA l Department of Obstetrics and Gynecology, Harbor-UCLA Medical Center, Torrance, CA 90509-2910, USA m Division of Adolescent Medicine/Children's Hospital of Michigan and Wayne State University School of Medicine, Detroit, MI 48201, USA n Division of Pediatric Endocrinology, Stanford University School of Medicine, Stanford, CA 94305-5208, USA Received 22 December 2009; revised 14 April 2010; accepted 20 April 2010 Abstract Background: It is unclear why some adolescents experience substantial bone mineral density (BMD) loss, while others experience a minimal decrease during depot medroxyprogesterone acetate (DMPA) use. We examined biopsychosocial factors in adolescents who experienced ≥5% BMD loss from baseline compared with adolescents who experienced b5% BMD loss during DMPA use. Study Design: A multicenter, prospective, nonrandomized study of 181 female adolescents who initiated DMPA for contraception was conducted. BMD (by dual-energy X-ray absorptiometry) and serum estradiol were measured at initiation and every 6 months for 240 weeks of DMPA use. Results: Half of participants experienced BMD loss of ≥5% from baseline at the hip, and a quarter experienced BMD loss of ≥5% at the lumbar spine (BMD substantial losers, SL). Hip and lumbar spine BMD-SL received a significantly greater number of DMPA injections than non-SL (pb.001). Decreased estradiol levels did not statistically differ between BMD loss subgroups. Hip BMD-SL had significantly lower baseline body mass index (BMI) than non-SL (p=.002), and there was an inverse relationship between weight gain and degree of BMD loss. Mean calcium intake was significantly lower (pb.05) in hip BMD-SL, and reported alcohol use was significantly higher (pb.05) in lumbar spine BMD-SL compared with non-SL. Contraception 82 (2010) 503 – 512 ⁎ Corresponding author. Division of Adolescent Medicine/Hasbro Children's Hospital and Department of Pediatrics/Warren Alpert Medical School of Brown University, Providence, RI 02903, USA. Tel.: +1 401 444 5188; fax: +1 401 444 6218. E-mail address: zharel@lifespan.org (Z. Harel). 0010-7824/$ – see front matter © 2010 Elsevier Inc. All rights reserved. doi:10.1016/j.contraception.2010.04.022