The relationship between depot medroxyprogesterone acetate (DMPA) and changes in bone mineral density remains controversial despite a substantial number of studies evaluating this potential association and its clinical relevance. While the majority of prospective studies suggest that DMPA produces a modest decline in bone density, several have failed to confirm this association, and none have documented any clinical consequences. The most recent data indicate that if bone density loss does occur in the presence of DMPA, it is reversible and unlikely to adversely influence clinical events either acutely or at a later time, such as in the postmenopausal period. In a risk:benefit evaluation, it is appropriate to consider any relationship between DMPA and changes in bone mineral density in the context of its established efficacy in pregnancy prevention.