What is a documented concern with long-term use of DMPA injections?

• A. Calcium alone
• B. Vitamin D supplementation only
• C. Vitamin D and calcium supplementation
• D. Vitamin C and calcium supplementation

Answer: (C)

Long-term DMPA use can lead to a decrease in bone mineral density, raising concern for weaker bones over time, especially in younger patients who are still building peak bone mass. To help counteract this, maintaining adequate calcium and vitamin D intake is recommended because calcium supplies the mineral for bone formation, while vitamin D improves calcium absorption and bone mineralization. The combination addresses the two key factors in bone health.

Calcium alone may improve mineral availability but without sufficient vitamin D, absorption can be limited. Vitamin D alone helps with absorption but, without enough calcium, bones still lack the necessary mineral. Vitamin C doesn’t play a primary role in preventing DMPA-associated bone loss. Therefore, the option that includes both vitamin D and calcium supplementation best matches the documented concern and its management.