Re: Gyn: Osteopenia pre-menopausally
From: art fougner, md (evsono@pipeline.com)
Thu Oct 20 15:03:17 2005
God forbid there'd be a National License to Practice Medicine and
deprive 50 states of their fiefdoms.
art
At Thu, 20 Oct 2005, ainsron wrote:
>
>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
--
art fougner, md
"I knew I was going to take the wrong train, so I left early."
Lawrence Peter Berra
