Is osteoporosis a concern with long-term DMPA?
"A patient has been receiving depot medroxyprogesterone (DMPA) and doing very well on it for six years. She's experienced none of the usual side effects. She rarely has breakthrough bleeding, no acne, no weight gain and excellent birth control. There aren't any atrophic vaginal changes either," explains JUDY L. PATTERSON, MD, of Calgary, AB. She asks, "Is there any concern of osteoporosis? Do I need to interrupt her excellent situation and recommend another birth control method? Should I recommend a bone mineral density (BMD) assessment even though she's young, healthy, active and has no apparent fracture risk?"
DMPA maintains estrogen levels at early follicular phase levels, which can be low -- that's where the concern of osteoporosis comes into play. If a patient doesn't have a family history of bone loss or any other risks, my practice has been to order a BMD test after a few years of therapy to serve as a baseline. Continue to advise all women, whether they're on DMPA or not, about the benefits of calcium, vitamin D and exercise, and the hazards of smoking, all of which can affect bone density. FW