Background Depot medroxyprogesterone acetate (Depo Provera ® ) is a popular contraceptive method among adolescents. Little is known, however, about the long term effects of Depo Provera ® on bone mineral density in adolescent females. This ongoing study prospectively evaluates the effects of Depo Provera ® and oral contraceptive pills on bone mineral density, compared to normally menstruating adolescents receiving no hormonal contraception. Methods From March 1, 1995 to December 31, 1997, 55 patients aged 12 to 17 presenting for new start hormonal contraception (Depo Provera ® : n = 30, oral contraceptive pills: n = 25) received baseline lumbar vertebral bone mineral density evaluation by dual energy x-ray absorptiometry (DEXA). Patients continuing with their original contraceptive method received bone mineral density evaluation every six months. Patients who subsequently discontinued hormonal contraception, became, pregnant or switched to an alternative contraceptive method were removed from the study. Exclusion criteria included prior use of hormonal contraception, previous pregnancy, and pre-existing risk factors for osteoporosis. Results Baseline DEXA scans revealed no significant difference in bone mineral density between the three groups. After 1 year, bone mineral density decreased from baseline by 0.017 gm/cm 2 or 1.8% in the Depo Provera ® group (n = 15), and increased by 0.030 gm/cm 2 or 3.0% in the oral contraceptive group (n = 8), p = 0.013. Bone mineral density increased by 0.0093 gm/cm 2 or 1.2% in the normally menstruating group over 1 year. After 18 months, bone mineral density decreased from baseline by 0.036 gm/cm 2 or 3.8% in the Depo Provera ® group (n = 10), and increased by 0.062 gm/cm 2 or 6.1% in the oral contraceptive group (n = 4), p 2 (2.0%) in the same time period. A subset of patients receiving Depo Provera ® over 24 months (n = 5) experienced a decrease of 0.222 gm/cm 2 or 4.8% in bone mineral density from baseline. There were no significant differences between the Depo Provera ® and oral contraceptive groups with respect to body mass index, race, smoking, alcohol consumption, or osteoporosis risk factors. Conclusions Depo Provera ® administration in adolescent females appears to be associated with a decrease in bone mineral density which becomes more pronounced with long term use. This is particularly significant as peak bone mineral density is accrued during the adolescent years. Further research is needed to determine whether decreased skeletal bone mineralization induced by Depo Provera ® is reversible on discontinuation of Depo Provera ® , or may be prevented by the concurrent administration of anti resorptive/bone forming agents.