Which form of birth control is associated with an increased risk of osteopenia?

• A. Injectable progestin
• B. Intrauterine device
• C. Oral contraceptives
• D. Natural family planning

Answer: (A)

The form of birth control that increases the risk of osteopenia is the injectable progestin. Long-acting progestin-only injections suppress the hypothalamic-pituitary-ovarian axis, which lowers overall estrogen levels. Estrogen helps protect bone by minimizing bone resorption, so when its levels drop, bone density can decrease. This effect is most noticeable with extended use, particularly in adolescents and young adults, and bone density often begins to recover after stopping the injection, though recovery can take time.

Other options have little to no impact on bone density. IUDs (copper or hormonal) deliver minimal systemic hormones, and natural family planning involves no hormones at all, so neither is associated with osteopenia. Combined oral contraceptives contain systemic estrogen and progestin and are not linked to the same bone-density loss, and may even support bone health in many users.