Drug-Induced Osteoporosis

Osteoporosis is a condition where the skeleton is lacking minerals (calcium) that keep the bones hard and strong. This condition can result because of side-effects from certain medications. Certain medicines can cause the bones to become "soft", or to lose hardness. When the bones become softer they are more prone to break. The fractures that result from this can be very painful and debilitating. They include fractures such as vertebral column compression fractures (spine fractures), hip fractures, wrist fractures, and rib fractures.

There are many drugs able to cause osteoporosis:

Drug Class Generic Names Brand Names Mechanism of Effect Therapy
Glucocorticoids Prednisone, Prednisolone, Dexamethasone   decreased bone formation due to impaired osteoblast differentiation & function; increased bone resorption Ca, vitamin D, Bisphosphonates, Teriparatide
Thyroid Hormone L-thyroxine, Liothyronine, thyroid USP   Increased bone resorption directly and by cytokine production Ca, vitamin D, Bisphosphonates
Aromatase Inhibitors Letrozole, Anastrazole, Exemestane   Increased bone turnover Zoledronic acid, Risedronate
Ovary function suppressing agents Medroxyprogesterone acetate, gonadotropin releasing hormone agonists   Ovarian sex-steroid hormone suppression Discontinue use
Androgen hormone deprivation therapy     Reduction of testosterone and estradiol levels Ca, vitamin D, Bisphosphonates, raloxifene, toremifene
Thiazolidinediones Rosiglitazone, Pioglitazone Actos, Avandia Decreased osteoblast formation, increased IGF-1 levels cause reduced bone formation, increased osteoclast  differentiation and bone resorption Discontinue use
Selective Serotonin Reuptake Inhibitors Paroxetine, Sertraline, Fluoxetine, Citalopram, etc Paxil, Zoloft, Prozac, Celexa, etc Serotonin receptors and transporters on osteoblasts and osteocytes influence bone metabolism Ca, vitamin D, Bisphosphonates
Anti-Seizure Drugs (controversial) Phenytoin, Valproate, Carbamazepine Dilantin, Depakote, Tegretol Mechanism unclear, but vitamin D metabolism is accelerated, possible inhibitors of osteoblast formation, anti-androgen effects (Val and Carb) Ca, vitamin D
Heparin Heparin   Decrease bone formation and increased bone resorption by  Use fondaparinux
Oral Anticoagulants (controversial) Warfarin Coumadin Decrease osteocalcin in the matrix Change
Loop Diuretics Furosemide, bumetanide Lasix, Bumex Inhibit calcium reabsorption Change
Calcineurin Inhibitors Cyclosporine, tacrolimus   Markedly increase bone reabsorption, alter vitamin D metabolism inducing secondary hyperparathyroidism Ca, vitamin D, Bisphosphonates
Anti-retroviral Therapy     Increase osteoclast formation, increase bone reabsorption, cause mitochondrial damage impairing osteoblast function and bone formation Ca, vitamin D, Bisphosphonates- alendronate and zoledronic acid
Proton Pump Inhibitors Omeprazole, Pantoprazole, Lansoprazole, Rabeprazole, Dexlansoprazole, Esomeprazole Prilosec, Protonnix, Prevacid, Aciphex, Dexilant, Nexium Decrease intestinal calcium absorption Change to Histamine blockers

No claims are made as to the accuracy or completeness of this table, use it at your own risk, or discuss what it has to say with me for further clarification.

Liberally excerpted from Mazziotti, et al, Drug-induced Osteoporosis: Mechanisms and Clinical Implicartions, The American Journal of Medicine (2010) 123, 877-884.

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