Bone loss associated with long-term use of depot medroxyprogesterone acetate

On 17 November 2004, the United States Food and Drug Administration issued a black box warning on the long-term use of depot medroxyprogesterone acetate stating that bone loss might be irreversible with use of more than 2 years. Despite the seriousness of such a safety warning, the Food and Drug Administration provided no clinical recommendations. Various professional bodies have made different recommendations on the management of women prescribing such long-term injections but there is no consensus on the best practice. Thus individual institutions need to revise service protocols. The Health Services Subcommittee of the Family Planning Association of Hong Kong has reviewed the scientific evidence from international and local studies and made its recommendations in a meeting held on 1 March 2005. This article aimed to share our opinion with other medical professionals in Hong Kong.