The Silent Threat: How Medications Can Harm Your Bones

Osteoporosis isn't just about getting older or estrogen drops after menopause. Up to 30% of cases in postmenopausal women can be caused by certain medications, a problem known as medication-induced osteoporosis.

The sobering facts on medication-induced bone loss

• High incidence of bone-damaging drugs: one study found that 76% of patients hospitalized for fractures were taking at least one non-opiate drug that could decrease bone density, increase fall risk, or increase fracture risk in the four months leading up to their hospitalization.
• Continued use post-fracture: worryingly, the number of medications increasing osteoporosis and fracture risk did not decrease when these patients were discharged.
• Significant fall risk in older adults: a striking 95% of individuals aged 65 or older are prescribed a medication that elevates their risk of falling.

Polypharmacy: a growing concern

Taking multiple medications, or “polypharmacy,” significantly increases the risk of falls and hospitalizations.

• 70% of adults aged 40–79 use at least one prescription medication.
• 85% of individuals aged 60 or older use at least one prescription drug.
• Among those 65 and above, 57% of women and 44% of men take at least five medications, with 12% taking ten or more.
• In long-term care facilities, 91% of patients take five or more medications.

Common medications that threaten your bones

Several medication classes are known to damage bone and increase fracture or fall risk:

• Acid blockers: proton pump inhibitors (PPIs) and H2 blockers can increase fracture risk with long-term use. The FDA warned in 2010 about the potential for PPI-induced hip, spinal, or radial fractures.
• Androgen-deprivation therapy (ADT): used for prostate cancer, ADT can dramatically increase osteoporosis prevalence (35% in hormone-naive patients, rising to 81% after 10 years of ADT).
• Antidepressants (SSRIs/SNRIs): postmenopausal women taking SSRIs can experience a 60% higher rate of bone loss; a meta-analysis showed a 13.4% fracture risk over 1 to 5 years of SSRI use, and a 10-year Canadian study found SNRIs also increase fracture risk by 68%.
• Antipsychotics: various antipsychotic medications are linked to bone health issues.
• Antiseizure medications: certain antiseizure medications can negatively impact bone density.
• Aromatase inhibitors: used in breast cancer treatment, these drugs are a significant cause of bone loss.
• Blood pressure medications: while essential, all blood pressure medications can increase fall risk if blood pressure drops too low.
• Chemotherapy: certain chemotherapy agents can contribute to bone loss.
• Depot medroxyprogesterone acetate (DMPA): this contraceptive can impact bone health.
• Diabetes medications (thiazolidinediones): certain diabetes medications are associated with increased fracture risk.
• Glucocorticoids: these powerful anti-inflammatory drugs are a major cause of medication-induced osteoporosis. Fractures can occur in 30–50% of patients on chronic glucocorticoid therapy.
• Heparin: this anticoagulant can lead to bone loss.
• Hypnotics (for anxiety and sleep): medications like Xanax, Ambien, and Klonopin can increase fall risk.
• Immunosuppressants: cyclosporin and tacrolimus can negatively impact bone health.
• Muscle relaxants: these can increase fall risk.
• Opioids: opioids are known to increase the risk of falls.
• Thyroid hormone: when dosed too high, thyroid hormone can damage bones.

Addressing medication-induced bone loss

• Deprescribing: a crucial aspect of managing osteoporosis is “deprescribing” medications that contribute to bone loss and fractures. This involves a careful review of all medications to identify and potentially reduce or switch those with adverse bone effects.
• Open communication with your healthcare provider: it's essential to discuss all medications you are taking, including over-the-counter drugs and supplements, to assess their potential impact on your bone health and discuss prevention and management strategies.

If you're taking any of these medications and are concerned about your bone health, bring it up at your next visit—never stop a prescribed medication on your own, but do make sure someone is looking at the whole picture.