Common Questions
What medications are associated with an increased risk of osteoporosis?
| Drug |
Mechanism |
| Corticosteroids at doses of greater than 2.5 mg. daily |
- Inhibit osteoblast activity by decreasing recruitment and decreasing osteoid synthesis. Causes decreased bone formation (1).
- Reduce calcium absorption by causing atrophy of jejunal mucosal cells (1).
- Sex hormone deficiency
|
|
- High dose only: (> 20 mg /day)
- Increase bone resorption due to secondary hyperparathyroidism.
- Increase renal calcium excretion.
|
| Cyclosporin, tacrolimus |
Unknown. Unclear if effect is independent of corticosteroids (2). |
| Methotrexate |
Unknown. Unclear if effect is independent of corticosteroids, but demonstrated to magnify corticosteroid-induced bone loss (3, 4). |
| Dilantin, phenobarbital |
- Inhibit calcium absorption.
- Accelerate vitamin D metabolism and clearance via liver enzyme induction.
|
| Thyroid hormone |
Iatrogenic hyperthyroidism (if over-replaced) |
| Loop diuretics |
Increased renal calcium excretion. |
| Heparin (high dose) |
Unknown |
| Depot medroxyprogesterone (5, 6) |
Estrogen deficiency |
| GNRH antagonists (7) |
Estrogen deficiency |
- Lane NE, Lukert B. The science and therapy of corticosteroid-induced bone loss. Endocrinol Metab Clin North Am 1998; 27: 465-483.
- Favus M (ed). Primer on the Metabolic Bone Diseases and Disorders of Mineral Metabolism. Lippencott, Williams & Wilkins: Philadelphia 1999; Fourth ed.
- Singwe M, Le Gars L, Karneff A, Prier A, Kaplan G. Multiple stress fractures in a scleroderma patient on methotrexate therapy. Rev Rhum Engl Ed 1998; 65: 508-510.
- Buckley LM, Leib ES, Cartularo S, Vacek PM, Cooper SM. Calcium and vitamin D supplementation prevents bone loss in the spine secondary to low dose corticosteroids in patients with rheumatoid arthritis: a randomized, double-blind, placebo controlled trial. Annals of Internal Medicine 1996; 125: 961-986.
- Bahamondes L, Perrotti M, Castro S, Faundes D, Petta C, Bedone A. Forearm bone density in users of Depo-Provera as a contraceptive method.. Fertil Steril 1999; 71: 849-852.
- Tang OS, Tang G, Yip P, Li B, Fan S. Long-term depot medroxyprogesterone acetate and bone mineral density. Contraception 1999; 59: 25-29.
- Finkelstein JS, Arnold AL. Increases in bone mineral density after discontinuation of daily human parathyroid hormone and gonadotropin-releasing hormone analog administration in women with endometriosis. J Clin Endocrinol Metab 1999; 84: 1214-1219.
Last updated 2009-07-03