DMPA and Bone Health: Settling a Fractious Issue

Concerns about the effects of depot medroxyprogesterone acetate (DMPA) on bone health resulted in a black box warning for injectable contraception, and have been hard to lay to rest. In a retrospective cohort study involving 18 years of data from the U.K. General Practice Research Database, investigators identified 312,395 women who used prescription contraception. During 1,722,356 woman-years of follow-up, 11,822 fractures were identified in DMPA users and nonusers.

Overall, absolute fracture rates remained below 1 per 100 woman-years in DMPA users. Analysis of a subcohort of 166,367 women with ≥6 months of baseline history showed that before they initiated contraception, women who chose DMPA had higher fracture risk than those who chose ot…