On DMPA, be Sure to Drink Your Milk but Don't Stop Your Birth Control!

Milk isn't the only way to get calcium into your bones, but if you are on Depo-Provera (DMPA) you may want to look at the calcium and vitamin D and exercise plan you have for bone health. Although we've had many studies over the years showing that long term use of the contraceptive DepoProvera lowers bone thickness, there wasn't much data linking that to greater fracture risks, although the FDA, but not the World Health Organization )WHO) did put a "Black Box" warning out about the risk of "long term" use of Depo-Provera and possible impact on bone health. Lower bone mass in older women causes osteoporotic fractures, lower bone mass in young women just puts you at risk for this problem in older age.

We know breast feeding our babies lowers bone thickness to about the same degree, but we don't want to stop breast feeding the babies! And like the breast feeders, who lose bone when they feed their baby they gain it right back afterwards and don't seem to be at risk for fractures. In some studies when women taking Depo-Provera for 5 years for contraception, did stop they also re-gained lost bone. It is important to say that it probably takes 3 years to regain that lost bone as in the study after two years off of Depo-Provera most users for over 5 years had not quite gotten back to their baseline bone status. However in a contrary study by Cromer and her colleagues in Cleveland, Ohio, reported in 2005, did show in teens who lost bone when on the Depo-Provera, usually gained that lost bone back by 12 months.

It is now been shown, through a retrospective study, by  Dr. Christoph R. Meier of University Hospital Basel in Switzerland and his colleagues and then August 4th in the Journal of Clinical Endocrinology and Metabolism online, that there was an increased fracture risk in women using Depo-Provera. The degree of fracture was very significant, and there haven’t been many studies to compare this one too. The researchers showed that looking at this group of 17,000+ UK  women with fractures and over 70,000 that had not had fractures and found that 1,300, or about 8%, sustained fractures during 26 years of follow-up. Based on this figure, and the new findings, a woman using Depo-Provera for at least 30 months would have a 12% likelihood of breaking a bone over the next couple of decades. A reanalysis of that data says the fracture risk in this small group was before they ever started on Depo-Provera!

And the newest study to weigh in has been done in Brasil at the University of Campinas in Sao Paulo showing that actually women who did use DMPA while breastfeeding had better wrist bone mass at 6 months than women who did not use contraception. Their information seemed to say that all the progesterones, the levonorgesterrel-releasing IUD as well as the progesterone only pills (POP) all improved bone mass relative to those that were not contracepting with hormones.

Reminding people that bone health is an important question when on Depo-Provera 2004, the U.S. Food and Drug Administration and Pfizer, the company that makes Depo-Provera, added a warning to the drug's labeling stating that use of the contraceptive can lead to loss of calcium in the bones, and that greater loss occurs with longer use. The label advises women against using the drug for longer than two years, stating that they should do so "only if other birth control methods are inadequate."In an editorial in August 2011 in OBG Management Drs. Andrew Kaunitz and David Grimes say that this warning is not based on the overwhelming facts and that the warning on the label, which appears in a "black box" is harmful to women as it unfairly makes people abandon excellent birth control. They argue that the FDA would never warn a woman who breast feeds that her skeletal health is in danger. And that would not make sense to warn people that their skeletal health is in danger just from breast feeding because it's only been linked to lower bone mass, not to fractures!

The FDA is not in step with the World Health Organization, the American Congress of Obstetricians and Gynecologist, the Society for Adolescent Medicine or the Society of Obstetrics and Gynecology of Canada, none of these organizations say that bone concerns should restrict Depo-Provera use for contraception!

So if you are on Depo-Provera, beyond dairy, don't forget those green leafy veggies! Come to see your gyno for your bone health and best contraceptive choices!

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