BMD Recovers After Discontinuing DMPA Contraception

Intramuscular injection of depot medroxyprogesterone acetate (DMPA) is a highly effective and popular form of contraception. It is used by about 2 million women in the US and 25 million women worldwide, according to Andrew Kaunitz, MD, from the University of Florida Health Science Center in Jacksonville, FL.

The biggest drawback to DMPA, he reminded yesterday's second session of Papers on Current Clinical and Basic Investigation, is an induced loss of bone mineral density (BMD). When DMPA was approved for use in the US, Dr. Kaunitz said, the Food and Drug Administration required a long-term study of BMD loss and the potential for recovery after discontinuation of use. Data from women who used DMPA for nearly 5 years and discontinued use for just under 2 years shows no lasting effect on BMD.

"This is the largest and largest term study yet," Dr. Kaunitz said. "From the data we have seen to date, there are no indications that DMPA has any implications for osteoporosis and fracture in postmenopausal women."

The open label, prospective, matched cohort study compared new DMPA users between the ages of 25 and 35 to a similar cohort using nonhormonal contraception, matched for race and smoking status. The study began with 228 women in the DMPA arm and 310 in the nonhormonal arm. Just 33 DMPA users and 105 nonusers completed 4.6 years of treatment and had spine BMD data available. The 1.8-year post-treatment phase included 41 DMPA users and 66 nonusers.

As expected, women using DMPA showed greater mean loss in BMD (P

Kaunitz AM, Kipersztok S. Evaluation of bone mineral density recovery following discontinuation of DMPA-IM contraception. Obstet Gynecol. 2005;105(4 suppl):6S.