title: Use of depot medroxyprogesterone acetate and fracture risk.
abstract: BACKGROUND
  Depot medroxyprogesterone acetate (DMPA), which has a high rate of use among teenagers in Europe and the United States, has been associated with impaired bone mineral acquisition during adolescence and accelerated bone loss in later life. Studies on the association between DMPA use and fracture risk are limited.
  
  
  OBJECTIVE
  We aimed at evaluating the relationship between use of hormonal contraceptives, specifically DMPA, and fracture risk.
  
  
  METHODS
  We conducted a case-control analysis using the United Kingdom-based General Practice Research Database.
  
  
  METHODS
  Participants were females aged 20-44 yr with an incident fracture diagnosis between 1995 and 2008.
  
  
  METHODS
  Odds ratios (OR) with 95% confidence intervals (CI) of incident fracture in relation to exposure to DMPA or combined oral contraceptives were assessed. Adjustments were made for smoking, body mass index, and additional potential confounders.
  
  
  RESULTS
  We identified 17,527 incident fracture cases and 70,130 control patients (DMPA exposure: 11 and 8%, respectively). Compared with nonuse, current use of one to two, three to nine, or 10 or more DMPA prescriptions yielded adjusted OR for fractures of 1.18 (95% CI = 0.93-1.49), 1.36 (95% CI = 1.15-1.60), and 1.54 (95% CI = 1.33-1.78), respectively. Fracture risk was highest after longer treatment duration (>2-3 yr), and there was no difference in patients below and above the age of 30 yr. For users of combined estrogen-containing oral contraceptives, the OR were around 1.
  
  
  CONCLUSIONS
  This population-based study suggests that use of DMPA is associated with a slightly increased risk of fractures.
authors.affiliation: Division of Endocrinology, Diabetes, and Metabolism, University Hospital Basel, Basel, Switzerland.
authors.forename: Christian
authors.initials: C
authors.lastname: Meier
authors.forename: Yolanda B
authors.initials: YB
authors.lastname: Brauchli
authors.forename: Susan S
authors.initials: SS
authors.lastname: Jick
authors.forename: Marius E
authors.initials: ME
authors.lastname: Kraenzlin
authors.forename: Christoph R
authors.initials: CR
authors.lastname: Meier
mesh_terms: D000328:Adult; D015519:Bone Density / Q000187:drug effects*; D003271:Contraceptive Agents, Female / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D050723:Fractures, Bone / Q000453:epidemiology* / Q000209:etiology*; D006801:Humans; D015994:Incidence; D017258:Medroxyprogesterone Acetate / Q000008:administration & dosage / Q000009:adverse effects*; D016017:Odds Ratio; D012306:Risk
chemical_list: D003271:Contraceptive Agents, Female; D017258:Medroxyprogesterone Acetate