Drug-Induced Osteoporosis.

Area of Science:

• Pharmacology
• Endocrinology
• Bone Biology

Background:

• Medications can cause bone loss as an adverse effect, leading to drug-induced osteoporosis.
• This condition is a significant cause of secondary osteoporosis and elevates fracture risk.

Purpose of the Study:

• To review the skeletal effects of commonly used drugs on bone metabolism, bone mineral density, and fracture outcomes.
• To highlight drug classes associated with drug-induced osteoporosis and discuss management strategies.

Main Methods:

• Literature review of selected commonly used medications.
• Summary of direct and indirect mechanisms of drug-induced bone loss.
• Discussion of clinical implications including fracture risk assessment and management.

Main Results:

• Medications can impair bone remodeling via direct effects on osteoblasts/osteoclasts or indirectly through metabolic disturbances (calcium, vitamin D, hormones).
• Key drug classes implicated include glucocorticoids, aromatase inhibitors, androgen-deprivation therapy, thyroxine, PPIs, anticoagulants, antidepressants, neuroleptics, and thiazolidinediones.
• Long-term use, especially in older individuals, necessitates proactive bone health consideration.

Conclusions:

• Drug-induced osteoporosis is a clinically relevant adverse effect requiring careful management.
• Proactive assessment including laboratory tests, fracture risk estimation (e.g., FRAX®), and BMD measurement is recommended.
• Ensuring adequate calcium and vitamin D intake and initiating guideline-based therapy are essential for patients on bone-damaging medications.