. Adequate calcium intake (28 servings or more a week) was associated with a significant decrease in the degree of BMD loss at the TH and FN in adolescents using DMPA. Furthermore, the adequate calcium intake group exhibited greater levels of FN BMD at 120 and 180 weeks after DMPA discontinuation. There was no significant effect of calcium intake upon LS BMD or whole body BMC. As with all female adolescents, adequate calcium and vitamin D intake should be encouraged in those using DMPA. Current guidelines recommend a calcium intake of 1300 mg/day and a minimum vitamin D intake of 400 IU/day for adolescent males and females [29,33]. Whether the adverse skeletal effects of DMPA can be reduced or prevented by ensuring adequate intake of calcium and vitamin D remains to be determined in future studies. Previous studies in adult women have shown that while some loss of BMD occurs in association with DMPA 288 Z. Harel et al. / Contraception 81 (2010) 281–291 exposure, BMD substantially recovers once DMPA is discontinued [22–26,34,35]. A recent review of 10 studies analyzing BMD changes after DMPA discontinuation found that BMD levels began to recover within 24 weeks of stopping DMPA and continued to rise during the follow-up periods [30]