Depo-Provera and Early-Onset Bone Loss: What young women need to know about osteoporosis and the birth control shot

A few weeks ago, a young woman (we’ll call her Maya) reached out to me after I shared an article I had written for IUDAlert titled: Depo-Provera is more than a Method of Birth Control—It’s a Means of Controlling Women in the “Depo Provera Side Effects” group on Facebook. 

In Maya’s message she stated, 

Was on it for 6 years as a teenager. I was recently diagnosed with Osteoporosis after breaking my hip while pregnant at the age of 37.” 

She continued on to say: 

I am a Registered Nurse who has not been able to work for almost the past 2 years due to my injury…This was also just my most recent fracture. Unfortunately, I have quite an extensive list of injuries related to bone loss.

What is osteoporosis?

According to the Mayo Clinic, osteoporosis is a condition that causes bones to become weak and brittle—so brittle that a fall or even mild stresses such as bending over or coughing can cause a fracture. Osteoporosis-related fractures most commonly occur in the hip, wrist, or spine. The disease, characterized by a decrease in bone tissue so that it becomes unusually porous, has historically occurred in postmenopausal women and the elderly. 

The National Women’s Health Network wrote an article in 2015 that detailed all the data in support of the connection between women who use the Depo-Provera birth control shot, and loss of bone mineral density (BMD), which may put them at higher risk for osteoporosis and bone fractures later in life. 

What are the risk factors for young women and osteoporosis? 

The Centre of Menstruation and Ovulation Research, (CeMCOR) founded by researcher and author Dr. Jerilynn Prior, an expert on progesterone therapy, states that although osteoporosis is rare in young women, it can occur. 

CeMCOR cites the following reasons for why a young woman could be at risk for osteoporosis in Young Women and Osteoporosis — Good news about treatment and prevention

Risk factors for young women include: 

  • No periods for three years
  • Skipping three or more periods
  • Amenorrhea or oligomenorrhea (medical terms for a menstrual cycle length longer than 36 days or skipping periods for up to six months).

According to CeMCOR, these factors cause bone loss, due to decreased estrogen levels that remain low for an extended period. Under these three risk factors, progesterone levels are also lower, which prevents the building of proper bone mineral density, especially during mid-teen formative years. It should therefore be noted that for the majority of women on Depo-Provera, the drug causes the cessation of one’s period, or amenorrhea

The anorexia and osteoporosis connection

Another factor common to young women that may compound their risk of osteoporosis is anorexia. 

According to the National Eating Disorders Association (NEDA), “at any given point in time between 0.3-0.4% of young women and 0.1% of young men will suffer from anorexia nervosa.”

While there is still a lot to be understood about the causes of anorexia, there are some factors affecting teen girls that put them at risk. 

  • Cultural beauty ideals
  • Relatives or friends who exhibit the behavior
  • Trauma, stress, depression, and other psychiatric issues
  • Personal genetics, hormonal issues, and other body chemistry issues

In 2003, ACTA Obstetricia et Gynecologica- Scandinavia (an international journal dedicated to providing the latest information on the results of both clinical and research work from around the globe) published a paper titled “Women with anorexia nervosa should not be treated with estrogen or birth control pills in a bone-sparing effect.” 

In the study abstract, it was noted that:

“Eating disorders are prevalent, serious conditions that affect mainly young women. An early and enduring sign of anorexia is amenorrhea.” 

The authors went on to state that there is “no evidence for benefits of hormone therapy in patients with anorexia; however, hormone medication and oral contraceptives are frequently prescribed for young women with anorexia as a prevention against and treatment for low bone mineral density.”

The researchers explained that the use of estrogens may “create a false picture” that the skeleton is being protected against osteoporosis. They concluded that the most important intervention for anorexia and the prevention of bone loss is to restore the menstrual periods through increased nutrition, and that hormone therapy and oral contraceptives should not be prescribed for young women with amenorrhea and concurrent eating disorders.

Considering the combined risks for young women for early onset bone loss

Between the factors outline by CeMCOR regarding prolonged missed periods–some of which may be due to the influence of Depo-Provera and other hormonal contraceptives–the use of these medications during a teen’s formative years, combined with cultural and hormonal issues, places this age group at a higher risk of developing osteoporosis sometime in their life. 

In 2005, Web MD published an article titled: “Teens’ Bones Recover After Ending Depo-Provera,” discussing a study that showed how bone loss could be regained when Depo-Provera use is discontinued. Lead researcher Dr. Delia Scholes, PhD, an epidemiologist with the University of Washington in Seattle, wrote that there have been few studies of Depo-Provera’s effects on adolescents, even though it is an important issue, because young girls are still building bones and bone loss in youth can affect lifelong risk of fractures

The study (and the article) were in response to the FDA’s 2004 issuance of a “black box” warning on all Depo-Provera packaging, stating that prolonged use of the contraceptive may result in the loss of bone density. A black box warning is the strongest “warning” issued by the agency. 

Unfortunately for Maya, the retired nurse quoted at the beginning of this article, prolonged use of Depo-Provera as a teenager might be the cause behind her extensive list of bone injuries, and the fact that at only 38-years-old, she is now retired from nursing due to her disability. But ever since making the connection between her teenage Depo use and her osteoporosis-related injuries, she has dedicated her time to researching Depo-Provera and bone loss. She writes: 

“I would love to help get this medication off the market and protect other women from ending up physically disabled at 38 years old like myself. Currently, I am desperately trying to find other women in the United States who have also suffered from these sorts of injuries due to their Depo-Provera usage.”

If you have experienced bone loss while on Depo-Provera or other hormonal contraceptives, please submit your story to Stories like Maya’s are the “real” data, describing how these potent drugs affect the lives and health of the women who take them, often unaware of the risks. And if the FDA does not respond to Natural Womanhood’s petition to remove Depo-Provera from the market, then we need other ways to make our voices heard. Sharing your story on IUDAlert is a strong first step.