Depo-Provera® use does not appear to increase fracture risk

Study results published in Obstetrics and Gynaecology demonstrates that the use of Depo-Provera® (depot medroxyprogesterone acetate), a long-term contraceptive agent, does not appear to increase fracture risk.(1)

Whilst the use of Depo-Provera® reduces serum oestrogen levels and is associated with significant loss of bone mineral density (BMD), this study shows that it does not appear to have an effect on fracture risk.(1,2)

The retrospective cohort study of 312,395 women, who had had 11,822 fractures, was designed to assess the extent to which depot medroxyprogesterone acetate (DMPA) increases fracture risk. Using data from the General Practice Research Database (GPRD), the study compared fracture incidence in DMPA users with women using non-DMPA hormonal contraceptives. It also investigated fracture incidence before and after initiation of contraceptive use.(2)

Although DMPA users had higher fracture risk than non-users, the risk did not increase after starting DMPA but was similar to before it was initiated.

Commenting on the results Professor Anna Glasier, Honorary Professor of the University of Edinburgh and the London School of Hygiene and Tropical Medicine, said “This study confirms what others have shown, that women who use Depo-Provera® appear to have a modest increase in fracture risk compared with women using other contraceptive methods. Importantly however, in this UK population the increased risk of fracture preceded the start of Depo-Provera®. The difference in fracture risk was mainly in fractures associated with trauma rather than those typical of osteoporosis. Further research is indicated to explore behavioural differences among populations of women choosing to use different contraceptive methods.”

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