Depo Provera and bone mineral density (BMD)

• in 2004, the CSM gave specific advice about Depo-Provera (a long-acting progestogenonly injectable contraceptive) in relation to bone mineral density
  • Depo-Provera reduces bone mineral density (BMD) in many women, but there is evidence that this starts to recover once Depo-Provera is stopped
  • currently no evidence that Depo-Provera use increases the risk of osteoporosis and fractures in later life, but this possibility should be considered when prescribing the product
  • CSM advise that in women with significant lifestyle and/or medical risk factors for osteoporosis, other methods of contraception should be considered
• there is evidence that Depo-Provera causes a loss of BMD in adolescents, at a time when BMD is normally increasing
  • CSM thus advise that, in adolescents, Depo-Provera may only be used as first-line contraception when other methods have been discussed and considered to be unsuitable or unacceptable
• care should also be taken in recommending Depo-Provera to women older than 40 years
  • note though that, in general, the benefits outweigh the risks in this age group, and it may be given if other methods are not suitable or acceptable
• CSM also advise that, in women of all ages, those who wish to continue Depo-Provera use for more than two years should have their individual clinical situations reviewed, with a re-evaluation of risks and benefits

Women using long-term (for at least two years) depot medroxyprogesterone acetate should be advised that treatment can reduce bone density but that the effects reverse when treatment is stopped and the overall risk of fracture is low (2)

The summary of product characteristics must be consulted before prescribing this drug.

Reference:

1. MeReC Bulletin 2006; 17(2):1-9.
2. SIGN (June 2020). Management of osteoporosis and the prevention of fragility fractures