The effects of depot medroxyprogesterone acetate and intrauterine device use on fracture risk in Danish women
Abstract
Background 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.
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DMPA use is associated with a modest increase in fracture risk, particularly in long-term users, with odds ratios no greater than 1.5.
“two large-scale, population-based, case-control studies [69,70] showed a modest increase in the risk in DMPA users, particularly in long term users (ORs ≤ 1.5).”
From Oral and depot progestin therapy for endometriosis: towards a personalized medicine (2017) · cites this paper as [69]
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References 39 · Cited by 51
- Authors
- Vestergaard, P., Rejnmark, L., & Mosekilde, L.
- Affiliations
- Aarhus University Hospital (DK)
- Corresponding author
- Vestergaard, Peter
- Venue
- Contraception
- Publisher
- Elsevier BV
- Published
- 2008-12
- Volume
- 78
- Issue
- 6
- Pages
- 459-464
- ISSN
- 0010-7824 (ISSN-L)
- OpenAlex
- W2127591758
- Cited by
- 51
- References
- 39
- Citations by year
- 2026: 2 · 2025: 1 · 2024: 1 · 2022: 1 · 2021: 3 · 2020: 2 · 2019: 3 · 2018: 4 · 2017: 2 · 2016: 5 · 2015: 3 · 2014: 6 · 2013: 3 · 2012: 3
- FWCI
- 3.96
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Contraception (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Reproductive Health and Contraception
- Health Sciences › Medicine › Orthopedics and Sports Medicine › Bone health and osteoporosis research
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Menopause: Health Impacts and Treatments
- Keywords
- depot medroxyprogesterone acetate, intrauterine devices, fracture risk, osteoporosis, hormonal contraception, bone health, residual confounding, Danish women
- MeSH terms
- Delayed-Action Preparations, Denmark, Female, Humans, Intrauterine Devices, Medicated, Life Style, Middle Aged, Registries, Time Factors, Confounding Factors, Epidemiologic, Body Mass Index, Confidence Intervals, Odds Ratio, Case-Control Studies, Medroxyprogesterone Acetate, Risk Assessment, Fractures, Bone
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