Depo-Provera and Bone Loss
Depo-Provera can cause significant bone loss, according to the drug’s prescribing information. The widely used contraceptive lowers estrogen levels, which may weaken bones and cause bone mineral density loss and an increased risk of fractures.
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Depo-Provera (medroxyprogesterone acetate) is a type of injectable birth control. It stops ovulation by blocking certain hormones in the body.
While it’s effective at preventing pregnancy, it also lowers estrogen, an essential hormone for healthy bones. This drop in estrogen can cause decreases in bone density — a measure of bone strength.
Bone loss risks were some of the earliest Depo-Provera side effects identified in clinical trials. Depo-Provera’s label must include a “black box” warning about possible bone density loss from prolonged use. Black box warnings are the most serious labels the U.S. Food and Drug Administration requires.
According to the warning, it is unknown if using Depo-Provera during the teen years or early adulthood affects bone strength later in life. Consequently, the drug’s prescribing information only advises long-term Depo-Provera use if a patient is medically unable to use other birth control options. Otherwise, if other options are available, those should be used instead.
Other Factors That Affect Bone Density
Bone mineral density measures the minerals in your bones and is linked to bone strength. In addition to certain medications, there are other factors to consider when determining your bone density risk.
- Age: Bone density typically decreases with age.
- Body Weight: Your weight can impact your bone density. Having a higher body weight can correlate with higher bone density.
- Family History: Genetics play a significant role in bone health.
- Gender: Bone density differences exist between men and women, with men generally maintaining bone density longer than women.
- Hormonal Changes: Hormonal changes during pregnancy and menopause can impact bone health. Bone loss during pregnancy typically recovers after birth. Bone loss can speed up through the post-menopausal years.
- Lifestyle: Alcohol use and smoking can harm bone density.
- Medications: In addition to Depo-Provera, certain breast cancer drugs, Prednisone, proton pump inhibitors (Prevacid, Nexium, Prilosec), blood pressure medication, anti-seizure and other drugs can cause bone loss.
- Nutrition: Adequate calcium and vitamin D are vital for strong bones.
- Physical Activity: Weight-bearing exercises can enhance bone density.
- Race: Variations in bone density can occur among different racial and ethnic groups. For example, bone mineral density tends to be higher among black women than white women, potentially contributing to lower fracture rates in African American women.
Depo-Provera can increase the risk of metabolic bone disease and osteoporosis, leading to weak bones, especially in people who already have some risk factors.
- Eating disorders like anorexia
- Family history of osteoporosis
- Heavy drinking and smoking
- Long-term use of certain medications, like seizure medications and steroids
If you have any of these other risk factors, you might want to ask your doctor about different contraceptive options.
Bone Loss in Young Women on Depo-Provera
Young women on Depo-Provera, especially those in their teens and early twenties, should be cautious about decreases in bone density.
According to the Depo-Provera label, researchers found that adolescents who used Depo-Provera CI for more than two years did not have their bone density at the hip and thigh area return to normal five years after stopping the medication.
The label also reveals that the same pattern occurred in adults. Two years after discontinuing treatment, bone density was slightly improved at the hip, thigh and lower back, but it did not fully return to pre-medication levels.
Fractures: Long-Term Health Implications of Bone Loss
Researchers don’t know the long-term effects of using Depo-Provera during the teenage years or early adulthood. Depo-Provera’s black box warning states this is a critical time for bone development.
Low bone density can result in significant health problems, especially osteoporosis. This condition makes bones more fragile by forming holes and thinning the outer cortex.
Consequently, the risk of fractures increases from minor incidents, such as a simple fall, particularly in older adults. Hip fractures, which are the most severe type of osteoporotic fractures, can lead to decreased mobility, loss of independence and higher mortality rates.
How To Prevent Bone Loss on Depo-Provera
While stopping Depo-Provera may reverse bone loss over time in some cases, the loss may not be completely reversible in others.
- Ask your doctor about switching to a different contraceptive with a lower bone loss risk.
- Eat a healthy diet.
- Get enough calcium and vitamin D.
- Exercise regularly, including weight-bearing exercise where you use your body weight to work against gravity, such as walking, dancing, strength training, elliptical machines, gardening, low-impact aerobics and stair climbing.
- Stop smoking.
- Limit alcohol to one drink per day.
You should have your weight and bone health checked regularly if you’re taking Depo-Provera. This is especially important if you have a family history of breast cancer or may be at risk of endometrial cancer.
Doctors recommend that anyone on Depo-Provera undergo a special endometrial sampling test every three to five months to check for changes that could indicate negative health issues.
Alternatives to Depo-Provera
Women concerned about bone loss may consider using Depo-Provera alternatives. Many of these are long-acting options, similar to Depo-Provera.
- Nexplanon (etonogestrel implant)
- A doctor inserts this contraceptive under the skin of your upper arm. It releases hormones slowly over three years. Studies suggest it does not significantly reduce bone density.
- Mirena (hormonal IUD)
- Mirina is a levonorgestrel-releasing intrauterine device. It is unlikely to impact bone health significantly.
- POP (progestogen-only pill)
- Sold under many brand names, this medication doesn’t have estrogen in it, making it a potentially safer choice for bone health.
- Combined oral contraceptive pill
- Sold under several brand names, including Yaz and Yasmin, these pills contain both estrogen and progestogen. Despite its estrogen content, no research has found a reduced bone density risk in adult women. However, it may affect adolescents who are still developing bone mass.
Bone Loss After Depo-Provera Use: Here’s What To Do
Bone loss from Depo-Provera is reversible for most women. However, women who used the medication during their teenage years or for a long time might experience longer-lasting effects.
If you’ve experienced bone loss as a side effect of Depo-Provera, you can take steps to improve your condition.
- Talk to your doctor.
- Stopping Depo-Provera injections can lead to significant recovery of bone mineral density (BMD). Most women recover some or all of their BMD within two to five years after stopping the medication. However, you should speak with your doctor before you stop taking your medication.
- Modify your lifestyle.
- Increase calcium and vitamin D intake through diet or supplements. Engage in weight-bearing exercises to promote bone strength. Avoid smoking and limit alcohol.
- Consider other risk factors.
- If you have additional risk factors for osteoporosis, like a family history, small frame or Caucasian or Asian ancestry, discuss them with your doctor.
- Monitor your bone density.
- If you have additional risk factors, your doctor may recommend you get regular bone density scans to track your BMD recovery after stopping Depo.
Recovery of BMD can take time. Improvements are often seen within two years post-treatment.
There may be other risk factors associated with Depo-Provera in addition to bone loss. Some people have experienced meningiomas, tumors that form in the lining of the brain, after prolonged use of the birth control shot. Talk to your doctor about side effects or health concerns associated with medications like Depo-Provera.
Frequently Asked Questions About Depo-Provera Bone Loss
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