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Comment on journal review of ‘Use of depot medroxyprogesterone acetate contraception and incidence of bone fracture’
Lanza, L., McQuay, L., Rothman, K., Bone, H. G., Kaunitz, A. M., Harel, Z., Ataher, Q., Ross, D., Arena, P. L., & Wolter, K. D. (2013). Comment on journal review of ‘Use of depot medroxyprogesterone acetate contraception and incidence of bone fracture’. Journal of Family Planning and Reproductive Health Care, 39(4), 306. https://doi.org/10.1136/jfprhc-2013-100759
We thank Dr Curry for an accurate summary1 of our study entitled ‘Use of depot medroxyprogesterone acetate contraception and incidence of bone fracture’.2 Nevertheless, we do not recommend more selective use of depot medroxyprogesterone acetate (DMPA) on account of fracture risk, as we believe that this recommendation would reduce access to an effective, safe contraceptive without actually reducing fracture risk. As we reported, in those subjects with at least 6 months of pre-DMPA medical history (176 pre-treatment fractures among 41 876 future DMPA users and 1574 fractures after starting DMPA) the incidence rate ratio (IRR) for fracture ‘after’ vs ‘before’ DMPA use was 1.08 [95% confidence interval (CI) 0.92–1.26]. We subsequently expanded that analysis to include up to 2 years of fracture history in the same subpopulation of 41 876 women (582 pre-treatment fractures in 64 737 patient-years; 1574 fractures after starting DMPA), which yielded IRR ‘after’ vs ‘before’ of 1.01 (95% CI 0.92–1.11), supporting our conclusion that DMPA had no meaningful effect on fracture risk in women who chose to use it.
