December 23, 2009

Bone Density Loss and Depo: Who’s at Risk?

The current issue of the journal Obstetrics & Gynecology includes an article on the risk of bone mineral density loss in users of contraceptive shots (DPMA, or brand name Depo Provera). As we mentioned in a previous post, the drug comes with a box warning that “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.”

The current study compared women who used DMPA for at least 24 months and had less than 5% vs. at least 5% bone loss to attempt to identify any characteristics that might be associated with a higher risk of bone loss.

The authors report that being a current smoker was associated with higher bone loss, while higher calcium intake (at least 600 mg/day) and having ever delivered a child were associated with lower levels of bone loss. Age, race or ethnicity, previous contraceptive use, and body mass index did not appear to be associated with higher bone mineral density loss.

Although only the abstract of the article is freely available, ScienceDaily provides an additional summary.

In other bone-related news, NPR published a piece this week, “How A Bone Disease Grew To Fit The Prescription,” which describes Merck’s approach to marketing the drug Fosamax, including its efforts to push smaller, cheaper machines to perform bone density scans (and for Medicare payment for the scans) and to expand the “osteopenia” diagnosis.

However, as the piece notes, “There are no long-term studies that look at what happens to women with osteopenia who start Fosamax in their 50s and continue treatment long-term in the hopes of preventing old-age fractures. And none are planned.”

The story and accompanying transcript provide a fascinating look at the marketing of a drug, from the perspective of a former Merck rep who believed he was helping save women from fractures through his marketing efforts, to criticisms of that work as “a plot to misdiagnose American women,” and the debate over whether women with slightly decreased bone density should be medicated at all.


3 Responses to “Bone Density Loss and Depo: Who’s at Risk?”

  1. karen Says:

    40 years ago I met original founding members of OBOS. I was in high school And now I am post menopausal. I can’t remember their names-Butterfield? I remember the husband, he worked with my boyfriend Peter, Jim? Anyway it was an exciting time in my life.

  2. riv Says:

    Thanks for this very helpful article. Regarding Fosamax et al: We have known for some time that osteopenia was an invented disease created to fit a drug that had no known usefulness. http://www.womenshealthmatters.ca/resources/show_res.cfm?ID=39815

    I question the whole bone loss myth. I think osteoporosis is created by our lifestyle, particularly the one women were forced to live in past years. I grew up and lived the majority of my life where there is only midnight sun. I didn’t drink milk until my mid-20s. I never took calcium or Vitamin D. I have only recently began taking both, low dose when needed, once, not for bone health, but because it helps with muscle pain and stiffness related to muscle and tendon injuries. (Try it.)

    I shatter the other shibboleth surrounding this “disease”: I grew up with about 95% of my diet as animal flesh.

    I’m 68 and have no osteoporosis or osteopenia. I never will have, and there is none in any family member. Yet, I have spent the years since menopause fighting off osteoporosis drugs and bone scans one after another. It’s a shilled and invented disease.

    The only real treatment for “thinning” bones is to never age. It is natural for bones to thin as we age. The only real treatment to prevent unhealthy bone structure (which is different from bone thinning) is weight bearing exercise.

    I didn’t have vehicle transportation until I was nearly 40. I walked everywhere, as did all my people. Even when we used the dogs, we ran alongside not wanting to tire them by having them pull us as well as the load.

  3. Kate Meredith Says:

    The FDA keeps uncovering quite extensive side effects of these contraceptive drugs years later which is certainly not encouraging for any woman taking any type of birth control. Seems more and more negative life-long issues are being brought to light. Wonder if we’ll ever find one that doesn’t have a massive toll on our bodies? I guess stopping what is a natural thing for women definitely isn’t natural by any means though.

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