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Drugs Causing Bone Loss.

Peter Vestergaard1,2

  • 1Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark. p.vestergaard@rn.dk.

Handbook of Experimental Pharmacology
|January 1, 2020
PubMed
Summary
This summary is machine-generated.

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Certain medications can lead to bone loss and increase fracture risk by affecting bone density, matrix integrity, or increasing fall risk. This review categorizes drugs by their impact on bone health.

Area of Science:

  • Pharmacology
  • Bone Biology
  • Gerontology

Background:

  • Medications can negatively impact bone health through various mechanisms.
  • Bone loss and increased fracture risk are significant clinical concerns, particularly in aging populations.
  • Dual energy absorptiometry (DXA) measures bone mineral density (BMD), but may not fully capture drug-induced bone fragility.

Purpose of the Study:

  • To systematically review drugs that induce bone loss or increase fracture risk.
  • To organize and present findings based on the Anatomical Therapeutic Chemical (ATC) classification system.

Main Methods:

  • Systematic literature review.
  • Analysis of drug mechanisms affecting bone mineral density and biomechanical competence.
  • Categorization of drugs by ATC classification.
Keywords:
AcetaminophenAndrogen deprivation therapyAntiepileptic drugsAntiviral therapyAromatase inhibitorsAzathioprineBone mineral densityBudesonideChemotherapyCyclosporineDepot medroxyprogesterone acetateFractureGlucocorticoidGnRH agonistHeparinLevothyroxineLoop diureticMethotrexateNeurolepticNon-steroid anti-inflammatoryOpioidOral contraceptivesParacetamolProtein pump inhibitorSedativesSelective serotonin reuptake inhibitorsStatinTamoxifenThiazideThiazolidinedonesThyroid hormonesVitamin AVitamin K antagonists

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Main Results:

  • Drugs impact bone by lowering sex steroid levels, interfering with vitamin D, or directly affecting bone cells.
  • Some drugs decrease BMD and increase fracture risk (e.g., thiazolidinediones, glucocorticoids).
  • Glucocorticoids and other drugs (e.g., SSRIs, NSAIDs) can increase fracture risk independently of BMD changes, potentially due to fall risk.

Conclusions:

  • A wide range of medications pose a risk to bone health.
  • Drug-induced bone loss and fracture risk involve complex mechanisms beyond BMD.
  • Understanding these drug effects is crucial for patient management and fracture prevention.