Short answer: Yes. The Depo-Provera label has a boxed warning that it can cause significant loss of bone mineral density, that the loss grows with longer use and may not be fully reversible. In adults, spine and hip density fell 5 to 6% over 5 years and only partly recovered 2 years after stopping. The label does not recommend it for longer than 2 years unless other birth control options are inadequate.
Depo-Provera CI is a progestin shot given every 3 months (13 weeks) to prevent pregnancy. The label (section 5.1) says it lowers estrogen levels and is linked to significant loss of bone mineral density (BMD). It calls this a particular concern in the teen and early adult years, when bone is still being built, and says it is unknown whether use at that age lowers peak bone mass and raises fracture risk later in life.
In a controlled study (section 14.2), women using Depo-Provera for up to 5 years lost 5 to 6% of spine and hip BMD on average, while the control group had no meaningful change. Most of the loss came in the first two years.
| Site | Depo-Provera at 5 years | Depo-Provera at 7 years (2 years off) | Control at 7 years |
|---|---|---|---|
| Spine | -5.38% | -3.13% | +0.53% |
| Total hip | -5.16% | -1.34% | +0.94% |
| Femoral neck | -6.12% | -5.38% | -0.11% |
The 7-year groups were small (7 to 13 women on Depo-Provera). The label says recovery was partial and that longer use was linked to less complete recovery.
A study of 389 girls aged 12 to 18 (section 14.3) found total hip BMD down 2.75% after about 1.2 years, 5.40% after 2.3 years and 6.40% after 4.6 years, while untreated girls gained bone. The groups were not matched, so the label treats the comparison with care. Spine loss was smaller, about 2%.
After stopping, girls who had used it for more than two years got their spine density back, but not their hip or femoral neck density, even 5 years (60 months) later. Smoking was also linked to less recovery. Since approval, the label adds, cases of osteoporosis including fractures have been reported in people using it.
The label does not recommend Depo-Provera as a long-term method (longer than 2 years) unless other options are inadequate, and says BMD should be checked if someone needs to stay on it long-term. It lists added risk factors that may make another method a better fit: bone disease, heavy alcohol or tobacco use, anorexia nervosa, a strong family history of osteoporosis, and long-term seizure or steroid medicines.
The patient leaflet says calcium, vitamin D and daily exercise may lessen the loss of calcium from bone, and MedlinePlus says to eat plenty of foods rich in both while on the shot. Dose Track logs each shot date, which makes the total time on Depo-Provera easy to see at a bone talk with the prescriber.
Read more on Dose Track: Depo-Provera side effects · Depo-Provera dosing schedule · Bone mineral density · Boxed warning