title: The use of depot-medroxyprogesterone acetate in contraception and its potential impact on skeletal health.
abstract: BACKGROUND
  In the fall of 2007, the controversy about the contraceptive use of depot-medroxyprogesterone acetate (DMPA) and its potential impact on skeletal health reached the media in the province of Quebec, Canada, thereby becoming a matter of concern for the lay public and physicians. In order to discuss this subject openly, the National Institute of Public Health of Quebec (INSPQ) organized a scientific meeting on February 15, 2008, with targeted physicians delegated by their medical associations in the fields of general practice, obstetrics and gynaecology, rheumatology, orthopaedic surgery, physiatry and endocrinology.
  
  
  METHODS
  Participants reviewed the scientific literature using the study classification method according to the level of evidence, reviewed published guidelines of medical societies and organizations on the subject and reached a consensus position. This manuscript presents a review of the literature and describes the consensus position of the targeted medical associations.
  
  
  RESULTS
  The consensus position adopted by all the targeted medical associations determined that DMPA was a cost-effective contraceptive option that must be considered in the light of the clinical situation and preference of each woman. Candidates for injectable contraception should be informed that the use of DMPA is associated with a slight decrease in bone mineral density (BMD), which is largely, if not completely, reversible. There should not be an absolute limit to the length of time that the DMPA contraceptive is used, regardless of the woman's age. Monitoring BMD is not recommended among users of DMPA for contraceptive purposes. Finally, the consensus statement declared that, although supplements of calcium and vitamin D are beneficial for skeletal health for women in general, such supplementation should not be recommended solely based on a woman's use of DMPA.
  
  
  CONCLUSIONS
  Given the scientific evidences, DMPA use remains a valid contraceptive option for women. Its potential impact on BMD must be balanced against the significant individual, familial and social consequences of unintended pregnancy.
authors.affiliation: National Institute of Public Health of Quebec, Quebec, Canada. edith.guilbert@inspq.qc.ca
authors.forename: Edith R
authors.initials: ER
authors.lastname: Guilbert
authors.forename: Jacques P
authors.initials: JP
authors.lastname: Brown
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Kaunitz
authors.forename: Marie-Soleil
authors.initials: MS
authors.lastname: Wagner
authors.forename: Jocelyn
authors.initials: J
authors.lastname: Bérubé
authors.forename: Louise
authors.initials: L
authors.lastname: Charbonneau
authors.forename: Diane
authors.initials: D
authors.lastname: Francoeur
authors.forename: Andrée
authors.initials: A
authors.lastname: Gilbert
authors.forename: François
authors.initials: F
authors.lastname: Gilbert
authors.forename: Geneviève
authors.initials: G
authors.lastname: Roy
authors.forename: Vyta
authors.initials: V
authors.lastname: Senikas
authors.forename: Robert
authors.initials: R
authors.lastname: Jacob
authors.forename: Réal
authors.initials: R
authors.lastname: Morin
mesh_terms: D015519:Bone Density / Q000187:drug effects*; D002170:Canada / Q000453:epidemiology; D003267:Contraception / Q000592:standards*; D003271:Contraceptive Agents, Female / Q000009:adverse effects*; D003692:Delayed-Action Preparations; D005260:Female; D050723:Fractures, Bone / Q000453:epidemiology; D006801:Humans; D017258:Medroxyprogesterone Acetate / Q000009:adverse effects*; D010024:Osteoporosis / Q000453:epidemiology*; D011247:Pregnancy; D018873:Pregnancy Rate
chemical_list: D003271:Contraceptive Agents, Female; D003692:Delayed-Action Preparations; D017258:Medroxyprogesterone Acetate