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Long-term use of injectable contraceptive without estrogen may increase fracture risk
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Using a common injectable contraceptive was associated with an increased risk of fractures, according to Swiss and U.S. investigators who collaborated on a case-controlled analysis.
They presented results of their study at the World Congress on Osteoporosis in Florence, Italy.
The investigators found that fracture risk was decreased when the contraceptive they studied, depot medroxyprogesterone acetate (DMPA), was used in combination with estrogen.
Previous studies have shown that use of DMPA is associated with impaired bone acquisition during adolescence and accelerated bone loss later in life, mainly in younger women with lower estrogen levels. However, few studies have looked into the impact of DMPA on fracture risk, according to a press release from the International Osteoporosis Foundation (IOF), which co-organized the congress with the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis.
Matched cohorts
The study, which was conducted at the University Hospital Basel, Switzerland, and Boston Medical Center, Lexington, Mass., showed a 50% increased risk of fracture when women younger than 50 years used DMPA for 2 years or more, according to the release.
Using a database, Swiss researcher Christian Meier, MD, and colleagues matched women who sustained incident fractures between 1995 and 2007 with four controls who matched the study group regarding age, gender, general practice, time of fracture and years registered in the database. They used conditional logistic regression and other statistical methods to stratify patients by their duration of contraception use. The investigators identified 71,089 incident fractures and 274,520 control patients, according to the abstract.
Widespread use
“In women below 50 years of age, longer-term use of MPA alone without use of estrogens is associated with an increased risk of fracture,” Meier and colleagues wrote.
DMPA is used by more than 9 million women worldwide and is widely used among teenagers in the U.S. and Europe.
- Reference:
Meier C, Kraenzlin ME, Meier CR, et al. Use of depot medroxyprogesterone acetate and fracture risk. Oral abstract #OC7. Presented at the IOF World Congress on Osteoporosis & 10th European Congress on Clinical and Economic Aspects of Osteoporosis and Osteoarthritis. May 5-8, 2010. Florence.
Meier has no direct financial interest in any products or companies mentioned in this article.
