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Re: Gyn: Osteopenia pre-menopausally From: ainsron (ainsron@sbcglobal.net) Thu Oct 20 13:50:03 2005 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: art fougner, md: "Re: Gyn: Osteopenia pre-menopausally" Previous message: Dr. Bülent Potur: "Re: Gyn: Osteopenia pre-menopausally" In reply to: Dr. Bülent Potur: "Re: Gyn: Osteopenia pre-menopausally" Thanks for the reference. Interesting how different groups look at the same data and come up with different recommendations, I guess it depends on whose ax they are grinding. Reminiscent of the VBAC controversy, HRT, etc. Unfortunately when faced with following the FDA suggestions or WHO suggestions - we are left with the local standard of care, not an international standard of care. Ronald E. Ainsworth, MD, FACOG -----Original Message----- From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Dr. Bülent Potur Sent: Thursday, October 20, 2005 9:37 AM To: Multiple recipients of list OB-GYN-L Subject: Re: Gyn: Osteopenia pre-menopausally I had forwarded this message to the list of Turkish gynecologists. A colleague expert in family planning replied that there is a WHO statement which does not approve the rather exaggerated FDA warning.: http://www.who.int/reproductive-health/family_planning/docs/hormonal_contrac eption_bone_health.pdf "Recommendations With regard to bone metabolism: • There should be no restriction on the use of DMPA, including no restriction on duration of use, among women aged 18 to 45 who are otherwise eligible to use the method. • Among adolescents (menarche to <18) and women over 45, the advantages of using DMPA generally outweigh the theoretical safety concerns regarding fracture risk. Since data are insufficient to determine if this is the case with long-term use among these age groups, the overall risks and benefits for continuing use of the method should be reconsidered over time with the individual user. • Recommendations regarding DMPA use also pertain to use of NET-EN. • There should be no restriction on the use of other progestogen-only contraceptive methods among women who are otherwise eligible to use these methods, including no restrictions on duration of use. • There should be no restriction on the use of combined hormonal contraceptive methods among women who are otherwise eligible to use these methods, including no restrictions on duration of use." Bulent Potur MD Obgyn Gynecology Obstetrics And Children's Hospital Kirikkale Turkey At Tue, 18 Oct 2005, ainsron wrote: > >That's exactly why the FDA came out with a black box warning last year >recommending that patient's should be switched to another method after two >years. Patients with other risk factors, such as this patient should never >be started on it in the first place: > >Women who use Depo-Provera Contraceptive Injection may lose significant bone >mineral density. Bone loss is greater with increasing duration of use and >may not be completely reversible. > >It is unknown if use of Depo-Provera Contraceptive Injection during >adolescence or early adulthood, a critical period of bone accretion, will >reduce peak bone mass and increase the risk of osteoporotic fracture in >later life. > >Depo-Provera Contraceptive Injection should be used as a long-term birth >control method (eg, longer than 2 years) only if other birth control methods >are inadequate (see WARNINGS). > >The WARNINGS section of the label also contains specific data regarding bone >loss from Depo-Provera Contraceptive Injection studies. Key additional >information in the WARNINGS section includes: > >. Use of Depo-Provera Contraceptive Injection reduces serum estrogen levels >and is associated with significant loss of BMD as bone metabolism >accommodates to a lower estrogen level. This loss of BMD is of particular >concern during adolescence and early adulthood, a critical period of bone >accretion > >. In both adults and adolescents, the decrease in BMD appears to be at least >partially reversible after Depo-Provera Contraceptive Injection is >discontinued and ovarian estrogen production increases > >. Depo-Provera Contraceptive Injection should be used as a long-term birth >control method (eg, longer than 2 years) only if other birth control methods >are inadequate. BMD should be evaluated when a woman needs to continue to >use Depo-Provera Contraceptive Injection long term. In adolescents, >interpretation of BMD results should take into account patient age and >skeletal maturity > >. Other birth control methods should be considered in the risk/benefit >analysis for the use of Depo-Provera Contraceptive Injection in women with >osteoporosis risk factors. Depo-Provera Contraceptive Injection can pose an >additional risk in patients with risk factors for osteoporosis (eg, >metabolic bone disease, chronic alcohol and/or tobacco use, anorexia >nervosa, strong family > >Ronald E. Ainsworth, MD, FACOG > >-----Original Message----- >From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of >Len2976@aol.com >Sent: Monday, October 17, 2005 9:30 PM >To: Multiple recipients of list OB-GYN-L >Subject: Re: Gyn: Osteopenia pre-menopausally > >We recently had a 21 y/o who has been on depo-provera for 3 years have a >DEXA showing >osteoporosis. The CNM I work with ordered the DEXA because the patient >expressed concern after reading an article. We switched her to ortho-evra >and started her on fosimax. She is 5'2", weighing about 110#, and possibly >her diet and calcium intake have been less than optimal during her teen >years. However, I have long been concerned about leaving these patients on >depo for years. > >Lenora McCall, CNM Next message: art fougner, md: "Re: Gyn: Osteopenia pre-menopausally" Previous message: Dr. Bülent Potur: "Re: Gyn: Osteopenia pre-menopausally" In reply to: Dr. Bülent Potur: "Re: Gyn: Osteopenia pre-menopausally"

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