Bone density in long term users of depot medroxyprogesterone acetate

Abstract

Objective To identify any adverse effect on bone density in long term users of depot Design Cross-sectional measurement of bone density in users with amenorrhoea of more than one Setting Community Family Planning Clinics in Portsmouth and Manchester.Population One hundred and eighty-five women aged 17-52 years (mean 33.3 years) who had used DMPA for between 1 and 16 years and were attending the clinics for further injections, between August 1994 and August 1996. Methods Dual energy X-ray measurement of bone density of femoral neck and lumbar spine, and venous blood sample taken just prior to the next injection of DMPA.Main outcome measures Bone density of femoral neck and lumbar spine and serum oestradiol in relationship to years of DMPA use and duration of amenorrhoea.Results Most women (n = 153) had serum oestradiol levels < 150 pmolll. Despite this, the mean bone density of the lumbar spine compared with the population mean for women aged 20-59 years gave a Z score (950/0 CI) of -0.332 (-0,510 to -0.154). There was no significant difference in the mean density of the femoral neck from the normal population mean.Conclusion Despite amenorrhoea and low serum oestradiol, this sample of long term DMPA users had bone density only minimally below the normal population mean. We therefore found no clinically important adverse effect on bone density and therefore no reason to recommend bone conserving measures, such as add-back oestrogen.medroxyprogesterone acetate (DMPA) for contraception.year or any woman using DMPA for more than five years.

FFPRHC Guidance (January 2005) Contraception for women aged over 40 years

“…Two studies have failed to show a correlation between serum oestradiol levels and BMD. 102,103 The CEU suggests that women aged over 40 years who are continuing or considering initiation of DMPA should be advised that studies have found an association between long-term use and loss of BMD. Women with additional risk factors for low BMD (i.e.…”

The members' enquiry service: frequently asked questions September 2001–August 2002 and an illustrative CEU response

“…A FACT 2 on Depo-Provera and bone density mentions that cross-sectional studies have shown that serum oestradiol levels in users may range from 15 to 318 pmol/l, [3][4][5][6] and that after up to 5 years of use most women have serum oestradiol levels above those of postmenopausal women. Additionally, these serum oestradiol levels are found to be in the early follicular phase range for women who ovulate.…”

“…In addition, the FACT mentions two studies that have shown that there is no significant correlation between bone density and serum oestradiol levels. 5,6 The recommendations made by the FACT are: l All women who are considering the use of DMPA should be told that studies have found an association between long-term DMPA use and loss of bone mass. l Women should be encouraged to build up, or maintain, their bone mass through attention to diet and exercise while those with risk factors for low BMD, such as smokers or those on long-term high-dose corticosteroid therapy, should be discouraged from using this contraceptive method.…”

Depo-Provera<SUP>®</SUP> and bone density

“…However, there are no published studies showing a linear relationship between oestradiol levels and BMD in these patients; in fact, two studies showed that there was no significant correlation between bone density and serum oestradiol level. 6,7 Several studies have sought to ascertain the effects of long-term use of Depo-Provera ® on bone density but the results have been mixed. This is not surprising given the fact that most of the studies have been cross-sectional in design, of short duration, and have used different measuring techniques at different sites in different population groups with small numbers.…”

“…4 Cross-sectional studies show that serum oestradiol levels range from 15 to 318 pmol/l. 3,[5][6][7] In nearly all women, after up to 5 years of Depo-Provera ® use, serum oestradiol levels remain above those found in postmenopausal women. Serum levels of oestradiol are maintained in the range found in the early follicular phase of women with ovulatory cycles.…”