Depot medroxyprogesterone acetate (DMPA) use may be associated with an increased risk of fractures; however, nothing is known about the risk associated with intrauterine contraceptive device (IUD) use.
Study Design
Case-control study. All women with a fracture (n=64,548) in the year 2000 in Denmark served as cases. For each case, three age-matched controls were randomly drawn from the general population (n=193,641). Exposure was present or previous DMPA or IUD use (only IUD coated with hormones, not those coated solely with copper). Adjustments were made for confounders.
Results
DMPA use seemed to be associated with an increased risk of fractures [odds ratio (OR)=1.44, 95% confidence interval (CI): 1.01-2.06], while IUD use appeared to be associated with a decreased risk of fractures (OR=0.75, 95% CI: 0.64-0.87).
Conclusion
DMPA use may cause an increased risk of fracture. However, the fact that use of DMPA is rare in Danish women and the lack of baseline data including smoking status and BMI does not allow causal inferences to be made. Likewise, the seemingly decreased risk of fractures with IUD use is probably not a pharmacological effect but rather the effect of residual confounding related to nonincluded confounders regarding lifestyle.
depot medroxyprogesterone acetate fracture risk case-control study, DMPA bone fracture risk Danish women population, intrauterine device hormonal IUD fracture risk, Vestergaard DMPA fracture risk Denmark case-control, injectable contraceptive bone health fracture outcomes, medroxyprogesterone acetate osteoporosis fracture epidemiology, hormonal IUD decreased fracture risk confounding, contraceptive methods bone mineral density fracture association, DMPA use skeletal health women case-control Denmark, progestin-only contraception fracture risk population-based study
PMID 19014791 19014791 DOI 10.1016/j.contraception.2008.07.014 10.1016/j.contraception.2008.07.014
Cite this article
Vestergaard, P., Rejnmark, L., & Mosekilde, L. (2008). The effects of depot medroxyprogesterone acetate and intrauterine device use on fracture risk in Danish women. *Contraception*, *78*(6), 459-464. https://doi.org/10.1016/j.contraception.2008.07.014
Vestergaard P, Rejnmark L, Mosekilde L. The effects of depot medroxyprogesterone acetate and intrauterine device use on fracture risk in Danish women. Contraception. 2008;78(6):459-464. doi:10.1016/j.contraception.2008.07.014
Vestergaard, P., et al. "The effects of depot medroxyprogesterone acetate and intrauterine device use on fracture risk in Danish women." *Contraception*, vol. 78, no. 6, 2008, pp. 459-464.
Objective: To examine trends in national reporting of broken intrauterine devices (IUDs).
Study Design: We enumerated IUD device "breakage" reports in the Food and Drug Administration Adverse Event R...
Objective: To evaluate overall and subgroup efficacy of an estetrol (E4) 15 mg drospirenone (DRSP) 3 mg oral contraceptive in a 24/4-day regimen.
Study Design: We pooled efficacy outcomes from 2 pivo...
Objective: The Natural Cycles app employs daily basal body temperature to define the fertile window via a proprietary algorithm and is clinically established effective in preventing pregnancy. We soug...
Objectives: To summarize the evidence on typical and perfect-use effectiveness of fertility awareness-based methods for avoiding pregnancy during the postpartum period, whether breastfeeding or not.
...