Priority 22 from the Contraception PSP

UNCERTAINTY: What are the health risks (osteoporosis, bone fracture) of using contraceptive injections, and do these increase with duration of use or vary with age of use? (JLA PSP Priority 22)
Overall ranking	22
JLA question ID	0049/22
Explanatory note	The June 14 Systematic review evaluated RCTs the outcomes assessed are bone mineral density assessed by scan, the hormone injection seems to reduce bone density. The same authors then conducted a systematic review of non random studies concluded that there was an increased risk of bone fracture in women who had used the contraceptive injection. This evidence was of moderate quality (Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.)
Evidence	Steroidal contraceptives and bone fractures in women: evidence from observational studiesLaureen M Lopez, Mario Chen, Sarah Mullins Long, Kathryn M. Curtis, Frans M Helmerhorst. July 2015 Steroidal contraceptives: effect on bone fractures in women. Laureen M Lopez, David A Grimes, Kenneth F Schulz, Kathryn M. Curtis, Mario Chen. CDSR June 2014 Hormonal contraception and bone metabolism: a systematic review, Carmine Nappi, Giuseppe Bifulco, Giovanni A. Tommaselli, Virginia Gargano, Costantino Di Carlo, Contraception, Vol. 86, Issue 6, p606–621, Published online: June 20, 2012, PreviewFull-Text HTMLPDF
Health Research Classification System category	Reproductive Health and Childbirth

Extra information provided by this PSP
Original uncertainty examples	“I've been on the Depo injection for over a decade now, and it's wonderful, but doctors keep telling me I can't stay on it- I have no familial risk of osteoporosis, have a good diet, and have never broken a bone, why am I being bullied into having periods when I don't want them?” (Patient) ~ “What is the evidence about bone mineral density and prolonged use of Depo-how can we best advise women who want to use Depo into their 40's?” (HCP)
Submitted by	Healthcare Professionals x 3~Patients x 2~Both x 2

Extra information provided by this PSP

Original uncertainty examples

“I've been on the Depo injection for over a decade now, and it's wonderful, but doctors keep telling me I can't stay on it- I have no familial risk of osteoporosis, have a good diet, and have never broken a bone, why am I being bullied into having periods when I don't want them?” (Patient) ~ “What is the evidence about bone mineral density and prolonged use of Depo-how can we best advise women who want to use Depo into their 40's?” (HCP)

Submitted by

Healthcare Professionals x 3~Patients x 2~Both x 2

PSP information
PSP unique ID	0049
PSP name	Contraception
Total number of uncertainties identified by this PSP.	57 (To see a full list of all uncertainties identified, please see the detailed spreadsheet held on the JLA website)
Date of priority setting workshop	21 April 2017