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: A 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 [2].
Continued Use Post-Fracture: Worryingly, the number of medications increasing osteoporosis and fracture risk did not decrease when these patients were discharged [2].
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 [3].
Polypharmacy: A Growing Concern
Taking multiple medications, or "polypharmacy," significantly increases the risk of falls and hospitalizations.
Prevalence:
70% of adults aged 40-79 use at least one prescription medication [5].
85% of individuals aged 60 or older use at least one prescription drug [5].
Among those 65 and above, 57% of women and 44% of men take at least five medications, with 12% taking ten or more [5].
In long-term care facilities, 91% of patients take five or more medications [6].
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 [8].
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) [10].
Antidepressants (SSRIs/SNRIs):
Postmenopausal women taking SSRIs can experience a 60% higher rate of bone loss [11].
A meta-analysis showed a 13.4% fracture risk over 1 to 5 years of SSRI use [12].
A 10-year Canadian study found SNRIs also increase fracture risk by 68% [13].
Antipsychotics: Various antipsychotic medications are linked to bone health issues [14].
Antiseizure Meds: Certain antiseizure medications can negatively impact bone density [14].
Aromatase Inhibitors: Used in breast cancer treatment, these drugs are a significant cause of bone loss (AIBL) [14].
Blood Pressure Meds: While essential, all blood pressure medications can increase fall risk if blood pressure drops too low [14].
Chemotherapy: Certain chemotherapy agents can contribute to bone loss [14].
Depot Medroxyprogesterone Acetate (DMPA): This contraceptive can impact bone health [14].
Diabetes Meds (Thiazolidinediones - TZDs): Certain diabetes medications are associated with increased fracture risk [14].
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 [14].
Heparin: This anticoagulant can lead to bone loss [14].
Hypnotics (for anxiety and sleep): Medications like Xanax, Ambien, and Klonopin can increase fall risk [14].
Immunosuppressants: Cyclosporin and Tacrolimus can negatively impact bone health [14].
Muscle Relaxants: These can increase fall risk [17].
Opioids: Opioids are known to increase the risk of falls [16].
Thyroid Hormone: When dosed too high, thyroid hormone can damage bones [15].
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.
Citations:
[1]: Fitzpatrick LA. Secondary causes of osteoporosis. Mayo Clin Proc. 2002;77(5):453-468.
[2]: Munson JC, Bynum JPW, Bell J-E, et al. Patterns of Prescription Drug Use Before and After Fragility Fracture. JAMA Internal Medicine. 2016;176(10):1531-1538.
[3]: Shaver AL, Clark CM, Hejna M, et al. Trends in fall-related mortality and fall risk increasing drugs among older individuals in the United States, 1999-2017. Pharmacoepidemiol Drug Saf. 2021.
[4]: Zaninotto P, Huang YT, Di Gessa G, Abell J, Lassale C, Steptoe A. Polypharmacy is a risk factor for hospital admission due to a fall: evidence from the English Longitudinal Study of Ageing. BMC Public Health. 2020;20(1):1804.
[5]: Hales CM, Servais J, Martin CB, Kohen D. Prescription Drug Use Among Adults Aged 40-79 in the United States and Canada. NCHS Data Brief. 2019(347):1-8.
[6]: Jokanovic N, Tan EC, Dooley MJ, Kirkpatrick CM, Bell JS. Prevalence and factors associated with polypharmacy in long-term care facilities: a systematic review. J Am Med Dir Assoc. 2015;16(6):535.e531-512.
[7]: FDA Drug Safety Communication: Possible increased risk of fractures of the hip, wrist, and spine with the use of proton pump inhibitors. US Food and Drug Administration.
[8]: Yang YX, Lewis JD, Epstein S, Metz DC. Long-term proton pump inhibitor therapy and risk of hip fracture. JAMA. 2006;296(24):2947-2953.
[9]: Morote J, Morin JP, Orsola A, et al. Prevalence of osteoporosis during long-term androgen deprivation therapy in patients with prostate cancer. Urology. 2007;69(3):500-4.
[10]: Diem SJ, Blackwell TL, Stone KL, et al. Use of antidepressants and rates of hip bone loss in older women: the study of osteoporotic fractures. Arch Intern Med. 2007;167(12):1240-1245.
[11]: Khanassov V, Hu J, Reeves D, van Marwijk H. Selective serotonin reuptake inhibitor and selective serotonin and norepinephrine reuptake inhibitor use and risk of fractures.
[12]: Moura C, Bernatsky S, Abrahamowicz M, et al. Antidepressant use and 10-year incident fracture risk: the population-based Canadian Multicentre Osteoporosis Study (CaMoS).
[13]:Moura C, Bernatsky S, Abrahamowicz M, et al. Antidepressant use and 10-year incident fracture risk: the population-based Canadian Multicentre Osteoporosis Study (CaMoS). Osteoporos Int. 2014;25(5):1473-1481.
[14]Panday K, Gona A, Humphrey MB. Medication-induced osteoporosis: screening and treatment strategies. Ther Adv Musculoskelet Dis. 2014 Oct;6(5):185-202. doi: 10.1177/1759720X14546350. PMID: 25342997; PMCID: PMC4206646.
[15]Delitala AP, Scuteri A, Doria C. Thyroid Hormone Diseases and Osteoporosis. J Clin Med. 2020 Apr 6;9(4):1034. doi: 10.3390/jcm9041034. PMID: 32268542; PMCID: PMC7230461.
[16]Virnes RE, Tiihonen M, Karttunen N, van Poelgeest EP, van der Velde N, Hartikainen S. Opioids and Falls Risk in Older Adults: A Narrative Review. Drugs Aging. 2022 Mar;39(3):199-207. doi: 10.1007/s40266-022-00929-y. Epub 2022 Mar 15. PMID: 35288864; PMCID: PMC8934763.
[17]Spence MM, Shin PJ, Lee EA, Gibbs NE. Risk of injury associated with skeletal muscle relaxant use in older adults. Ann Pharmacother. 2013 Jul-Aug;47(7-8):993-8. doi: 10.1345/aph.1R735. Epub 2013 Jul 2. PMID: 23821610.