Depot Medroxyprogesterone Acetate (Depo-Provera, DMPA) Effects on Bone Mineral DensityKim O'Connor, MD Literature reviewed August 23, 2007. Updated November 23, 2008
An 18 year old female is seeing you for her preventive health visit. She has been taking Depo Provera® (DMPA) for the past three years. She read something in a women's magazine about Depo Provera affecting bone density. She wants to know if this is something that she should be concerned about and if she should stop the medication.
- Remarkable for irregular menses.
- Weight 108 lbs. BMI 16
- FHx: No h/o osteoporosis
- Soc Hx:
- Occasionally smokes 2-4 cigarettes on the weekends
- She is a ballet dancer
- Depo Provera: 150 mg IM every three months
- Occasional multivitamin
Click an answer under each question.
What happens to bone mineral density (BMD) in adolescents on DMPA?
She wants to know if her risk of fracture is higher if she continues to take the DMPA? What do you tell her?
What is the mechanism of bone loss?
She wants to know if other progestogen-only forms of birth control have a similar effect on bone density as DMPA?
Does adding estrogen help to minimize bone loss?
Is there anything she can be doing to prevent additional bone loss?
What will happen to her bone density once she stops the DMPA?
- Option A When she becomes postmenopausal, her bone mineral density will be significantly lower than nonusers of DMPA
- Option B Her bone mineral density will increase more rapidly than nonusers of DMPA
- Option C Her bone mineral density will continue to decline at rates faster than in the nonusers of DMPA
- Option D There will no change in her bone density
Her mom told her to ask you to order a bone density (DEXA) scan. Which other elements in her history may make this a reasonable request?
She does not think that she can be compliant with other birth control options. She does not want an IUD or any type of implant. She wants to know if you feel that the DMPA should be discontinued. You tell her: