{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,18]],"date-time":"2026-10-18T06:39:15Z","timestamp":1792305555918,"version":"4.4.0"},"reference-count":79,"publisher":"SAGE Publications","issue":"10","license":[{"start":{"date-parts":[[2021,10,1]],"date-time":"2021-10-01T00:00:00Z","timestamp":1633046400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2021,10,1]],"date-time":"2021-10-01T00:00:00Z","timestamp":1633046400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of Women's Health"],"published-print":{"date-parts":[[2021,10]]},"abstract":"<jats:p>\n                    Bone mineral density (BMD) changes during the life span, increasing rapidly during adolescence, plateauing in the third decade of life, and subsequently entering a phase of age-related decline. In women, menopause leads to accelerated bone loss and an increase in fracture risk. Between peak bone mass attainment and menopause, BMD is generally stable and the risk of fracture is typically low. This time period is marked by life events such as pregnancy and lactation, which transiently decrease BMD, yet their long-term effects on fracture risk are less certain. BMD may also be altered by exposure to medications that affect bone metabolism (\n                    <jats:italic toggle=\"yes\">e.g.<\/jats:italic>\n                    , contraceptives, glucocorticoids, antidiabetic medications, antiepileptic drugs). Although oral contraceptives are often believed to be neutral with regard to bone health, depot medroxyprogesterone acetate (DMPA) and gonadotropin-releasing hormone (GnRH) agonists have been associated with decreases in BMD. Development of newer medical therapies, principally GnRH antagonists (\n                    <jats:italic toggle=\"yes\">e.g.<\/jats:italic>\n                    , ASP1707, elagolix, linzagolix, relugolix), for treatment of endometriosis-associated pelvic pain and heavy menstrual bleeding due to uterine fibroids has renewed interest in the short- and long-term impacts of changes in BMD experienced by premenopausal women. It is important to understand how these drugs influence BMD and put the findings into context with regard to measurement variability and naturally occurring factors that influence bone health. This review summarizes what is known about the effects on bone health pregnancy, lactation, and use of DMPA, GnRH agonists, and GnRH antagonists in premenopausal women and potential consequences later in life.\n                    <jats:uri xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"http:\/\/ClinicalTrials.gov\">ClinicalTrials.gov<\/jats:uri>\n                    identifier: NCT03213457.\n                  <\/jats:p>","DOI":"10.1089\/jwh.2020.8989","type":"journal-article","created":{"date-parts":[[2021,8,26]],"date-time":"2021-08-26T11:37:52Z","timestamp":1629977872000},"page":"1416-1430","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":39,"title":["Bone Mineral Density Changes Associated With Pregnancy, Lactation, and Medical Treatments in Premenopausal Women and Effects Later in Life"],"prefix":"10.1177","volume":"30","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0719-9801","authenticated-orcid":false,"given":"Nelson B.","family":"Watts","sequence":"first","affiliation":[{"name":"Mercy Health Osteoporosis and Bone Health Services, Cincinnati, Ohio, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neil","family":"Binkley","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Wisconsin, Madison, Wisconsin, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charlotte D.","family":"Owens","sequence":"additional","affiliation":[{"name":"AbbVie, Inc., North Chicago, Illinois, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ayman","family":"Al-Hendy","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, The University of Illinois College of Medicine, Chicago, Illinois, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth E.","family":"Puscheck","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Wayne State University, Detroit, Michigan, USA."},{"name":"InVia Fertility, Hoffman Estates, Illinois, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamad","family":"Shebley","sequence":"additional","affiliation":[{"name":"AbbVie, Inc., North Chicago, Illinois, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William D.","family":"Schlaff","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James A.","family":"Simon","sequence":"additional","affiliation":[{"name":"IntimMedicine Specialists, Washington, District of Columbia, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2021,10,5]]},"reference":[{"key":"e_1_3_4_2_2","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2011-1111"},{"key":"e_1_3_4_3_2","first-page":"135","article-title":"The influence of pregnancy and lactation on maternal bone health: A systematic review","volume":"8","author":"Salari P","year":"2014","unstructured":"Salari P, , Abdollahi M. The influence of pregnancy and lactation on maternal bone health: A systematic review. J Family Reprod Health, 2014; 8:135\u2013148.","journal-title":"J Family Reprod Health"},{"key":"e_1_3_4_4_2","unstructured":"American College of Radiology. ACR-SPR-SSR practice parameter for the performance of dual-energy X-ray absorptiometry (DXA). 2018. Available at: https:\/\/www.acr.org\/-\/media\/ACR\/Files\/Practice-Parameters\/DXA.pdf; accessed February11 2021."},{"key":"e_1_3_4_5_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00198-017-4171-4"},{"key":"e_1_3_4_6_2","doi-asserted-by":"publisher","DOI":"10.1080\/14740338.2018.1524868"},{"key":"e_1_3_4_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.bone.2014.12.013"},{"key":"e_1_3_4_8_2","doi-asserted-by":"publisher","DOI":"10.1517\/14656566.2014.888414"},{"key":"e_1_3_4_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.bone.2015.12.054"},{"key":"e_1_3_4_10_2","first-page":"CD009849","article-title":"Steroidal contraceptives and bone fractures in women: Evidence from observational studies","volume":"8","author":"Lopez LM","year":"2015","unstructured":"Lopez LM, , Chen M, , Mullins Long S, , Curtis KM, , Helmerhorst FM. Steroidal contraceptives and bone fractures in women: Evidence from observational studies. Cochrane Database Syst Rev, 2015; 8:CD009849.","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_3_4_11_2","doi-asserted-by":"publisher","DOI":"10.1007\/s13669-017-0201-7"},{"key":"e_1_3_4_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.fertnstert.2019.09.037"},{"key":"e_1_3_4_13_2","doi-asserted-by":"publisher","DOI":"10.1097\/BOR.0000000000000400"},{"key":"e_1_3_4_14_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00198-017-4258-y"},{"key":"e_1_3_4_15_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.288.15.1889"},{"key":"e_1_3_4_16_2","unstructured":"The International Society for Clinical Densitometry (ISCD). 2019 ISCD Official Positions 2019. Available at: www.ISCD.org Accessed May18 2020."},{"key":"e_1_3_4_17_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1756-185X.2008.00390.x"},{"key":"e_1_3_4_18_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00198-010-1339-6"},{"key":"e_1_3_4_19_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0047-6374(02)00199-9"},{"key":"e_1_3_4_20_2","volume-title":"Guidelines for preclinical evaluation and clinical trials in osteoporosis","author":"World Health Organization","year":"1998","unstructured":"World Health Organization. Guidelines for preclinical evaluation and clinical trials in osteoporosis. Geneva, Switzerland: World Health Organization, 1998."},{"key":"e_1_3_4_21_2","volume-title":"Osteoporosis: fragility fracture risk. NICE short clinical guideline\u2014CG146. London, United","author":"National Clinical Guideline Centre","year":"2012","unstructured":"National Clinical Guideline Centre. Osteoporosis: fragility fracture risk. NICE short clinical guideline\u2014CG146. London, United. Kingdom: National Clinical Guideline Centre, 2012."},{"key":"e_1_3_4_22_2","doi-asserted-by":"publisher","DOI":"10.1002\/jbmr.1476"},{"key":"e_1_3_4_23_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ando.2016.04.004"},{"key":"e_1_3_4_24_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1447-0756.1995.tb01031.x"},{"key":"e_1_3_4_25_2","doi-asserted-by":"publisher","DOI":"10.1042\/cs0940405"},{"key":"e_1_3_4_26_2","doi-asserted-by":"publisher","DOI":"10.1007\/s001980170048"},{"key":"e_1_3_4_27_2","doi-asserted-by":"publisher","DOI":"10.1055\/s-2003-41308"},{"key":"e_1_3_4_28_2","doi-asserted-by":"publisher","DOI":"10.1016\/S8756-3282(03)00017-6"},{"key":"e_1_3_4_29_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00404-002-0410-8"},{"key":"e_1_3_4_30_2","doi-asserted-by":"publisher","DOI":"10.1093\/humrep\/deh115"},{"key":"e_1_3_4_31_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.maturitas.2013.11.003"},{"key":"e_1_3_4_32_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.bone.2017.04.013"},{"key":"e_1_3_4_33_2","doi-asserted-by":"publisher","DOI":"10.1017\/S0007114508084067"},{"key":"e_1_3_4_34_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0020-7292(98)00155-6"},{"key":"e_1_3_4_35_2","doi-asserted-by":"publisher","DOI":"10.1007\/s001980050192"},{"key":"e_1_3_4_36_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.0001-6349.2004.00428.x"},{"key":"e_1_3_4_37_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00198-011-1767-y"},{"key":"e_1_3_4_38_2","first-page":"556","article-title":"Changes in body composition of Indian lactating women: A longitudinal study","volume":"25","author":"Kajale NA","year":"2016","unstructured":"Kajale NA, , Khadilkar VV, , Mughal Z, , Chiplonkar SA, , Khadilkar AV. Changes in body composition of Indian lactating women: A longitudinal study. Asia Pac J Clin Nutr, 2016; 25:556\u2013562.","journal-title":"Asia Pac J Clin Nutr"},{"key":"e_1_3_4_39_2","doi-asserted-by":"publisher","DOI":"10.1111\/apa.13102"},{"key":"e_1_3_4_40_2","doi-asserted-by":"publisher","DOI":"10.1155\/2014\/897182"},{"key":"e_1_3_4_41_2","doi-asserted-by":"publisher","DOI":"10.1590\/0102-311x00122018"},{"key":"e_1_3_4_42_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00198-015-3149-3"},{"key":"e_1_3_4_43_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10067-019-04758-0"},{"key":"e_1_3_4_44_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00198-010-1392-1"},{"key":"e_1_3_4_45_2","doi-asserted-by":"publisher","DOI":"10.1002\/jbmr.496"},{"key":"e_1_3_4_46_2","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000002096"},{"key":"e_1_3_4_47_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00198-018-4665-8"},{"key":"e_1_3_4_48_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11657-019-0601-6"},{"key":"e_1_3_4_49_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.fertnstert.2004.04.064"},{"key":"e_1_3_4_50_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.fertnstert.2006.05.024"},{"key":"e_1_3_4_51_2","volume-title":"New","author":"Depo-SubQ provera 104 (medroxyprogesterone acetate) [prescribing information]","year":"2019","unstructured":"Depo-SubQ provera 104 (medroxyprogesterone acetate) [prescribing information]. New. York, NY: Pharmacia & Upjohn Co, 2019."},{"key":"e_1_3_4_52_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.contraception.2006.03.010"},{"key":"e_1_3_4_53_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.AOG.0000450758.95422.c8"},{"key":"e_1_3_4_54_2","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2010-0032"},{"key":"e_1_3_4_55_2","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0b013e318283d1a1"},{"key":"e_1_3_4_56_2","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000003414"},{"key":"e_1_3_4_57_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00774-005-0618-3"},{"key":"e_1_3_4_58_2","first-page":"CD001297","article-title":"Gonadotrophin-releasing hormone analogues for endometriosis: Bone mineral density","volume":"4","author":"Farmer JE","year":"2003","unstructured":"Farmer JE, , Prentice A, , Breeze A, et al. Gonadotrophin-releasing hormone analogues for endometriosis: Bone mineral density. Cochrane Database Syst Rev, 2003; 4:CD001297.","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_3_4_59_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00404-014-3230-8"},{"key":"e_1_3_4_60_2","doi-asserted-by":"publisher","DOI":"10.1155\/2015\/934164"},{"key":"e_1_3_4_61_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejogrb.2019.02.032"},{"key":"e_1_3_4_62_2","doi-asserted-by":"publisher","DOI":"10.1177\/1933719114549848"},{"key":"e_1_3_4_63_2","doi-asserted-by":"publisher","DOI":"10.1177\/1933719113497292"},{"key":"e_1_3_4_64_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1700089"},{"key":"e_1_3_4_65_2","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000002933"},{"key":"e_1_3_4_66_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1904351"},{"key":"e_1_3_4_67_2","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000002675"},{"key":"e_1_3_4_68_2","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000003869"},{"key":"e_1_3_4_69_2","first-page":"i1","article-title":"The effect of elagolix, a novel, orally active GnRH antagonist, on bone mineral density (BMD) in women with endometriosis","volume":"33","author":"Ettinger B","year":"2012","unstructured":"Ettinger B, , Dmowski WP, , O'Brien C, et al. The effect of elagolix, a novel, orally active GnRH antagonist, on bone mineral density (BMD) in women with endometriosis. Endocr Rev, 2012; 33:i1\u2013i1057.","journal-title":"Endocr Rev"},{"key":"e_1_3_4_70_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2008283"},{"key":"e_1_3_4_71_2","doi-asserted-by":"publisher","DOI":"10.1093\/humrep\/dez028"},{"key":"e_1_3_4_72_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.fertnstert.2020.02.114"},{"key":"e_1_3_4_73_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11657-016-0280-5"},{"key":"e_1_3_4_74_2","doi-asserted-by":"publisher","DOI":"10.1002\/jbm4.10401"},{"key":"e_1_3_4_75_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2018.7498"},{"key":"e_1_3_4_76_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0029-7844(02)01943-9"},{"key":"e_1_3_4_77_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jocd.2011.05.014"},{"key":"e_1_3_4_78_2","doi-asserted-by":"publisher","DOI":"10.1089\/jwh.2017.6706"},{"key":"e_1_3_4_79_2","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2019-00221"},{"key":"e_1_3_4_80_2","doi-asserted-by":"publisher","DOI":"10.1210\/clinem\/dgaa048"}],"container-title":["Journal of Women's Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1089\/jwh.2020.8989","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1089\/jwh.2020.8989","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1089\/jwh.2020.8989","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T17:54:55Z","timestamp":1777658095000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1089\/jwh.2020.8989"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,10]]},"references-count":79,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2021,10]]}},"alternative-id":["10.1089\/jwh.2020.8989"],"URL":"https:\/\/doi.org\/10.1089\/jwh.2020.8989","relation":{},"ISSN":["1540-9996","1931-843X"],"issn-type":[{"value":"1540-9996","type":"print"},{"value":"1931-843X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,10]]}}}