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Re: Gyn: Osteopenia pre-menopausallyFrom: ainsron (ainsron@sbcglobal.net)Tue Oct 18 08:22:03 2005
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
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