Generally, osteoporosis is more common in women, especially postmenopausal women. This is because the lack of estrogen after menopause can lead to bone loss. Additionally, reduced calcium intake due to endocrine factors is another significant cause of osteoporosis. As people age, increased levels of parathyroid hormone in the elderly can also contribute to the development of osteoporosis.Some individuals develop osteoporosis due to long-term calcium deficiency, malnutrition, or inactivity. However, many may not be aware of drug-induced osteoporosis, also known as osteoporosis caused by medications.
Today, we'll help you identify the medications that can lead to osteoporosis.
Glucocorticoids
Glucocorticoids are the most common cause of drug-induced osteoporosis. Medications like dexamethasone and prednisone are the most frequent culprits. These drugs promote protein breakdown, inhibit protein synthesis, and increase calcium and phosphorus excretion. This reduces the synthesis of proteins and glycosaminoglycans, impairing the formation of bone matrix.These drugs suppress osteoblast activity and bone formation, reducing trabecular bone and osteoblast numbers, thereby causing osteoporosis. This is most common in children, postmenopausal women, and the elderly, with severe cases leading to spontaneous fractures. Therefore, individuals requiring long-term steroid use should concurrently take bone-strengthening medications, calcium supplements, and anti-osteoporosis drugs.
During glucocorticoid therapy, unexplained, progressively worsening back pain, joint pain, or joint stiffness unrelated to weather changes may indicate developing osteoporosis. Prompt medical consultation is essential. Follow medical advice to gradually taper or discontinue corticosteroids, or switch to alternative medications.
Thyroid Hormones
Thyroid hormones synergize with growth hormones to promote skeletal growth and development. However, excessive thyroid hormone use disrupts calcium-phosphorus balance, leading to bone demineralization, increased bone resorption, and ultimately osteoporosis.Patients should strictly follow medical advice for appropriate thyroid hormone dosing. Overmedication must be avoided to prevent drug-induced osteoporosis, as the risks outweigh the benefits.
Osteoporosis patients should be particularly mindful of this risk and consult their doctor about combining calcium and vitamin D supplementation.
Heparin
Patients using heparin (including unfractionated heparin and low molecular weight heparin) for over four months may develop osteoporosis or spontaneous fractures.Heparin-induced osteoporosis commonly affects the spine and ribs. The mechanism may involve increased collagen dissolution, accelerated bone resorption due to hyperthyroidism, and inhibition of bone formation. The risk of osteoporosis from low molecular weight heparin is lower than that from unfractionated heparin.
Prevention hinges on strict dose control, avoiding high-dose or prolonged heparin therapy.
Antiepileptic Drugs
Long-term use of antiepileptic drugs such as phenytoin sodium and phenobarbital promotes vitamin D degradation and reduces calcium absorption in the digestive tract, leading to hypocalcemia.Hypocalcemia can reduce bone mass by 10%–30%, potentially leading to osteoporosis and spontaneous fractures. Therefore, patients on long-term antiepileptic therapy should begin vitamin D and calcium supplementation 3–4 months after starting treatment.
Diuretics
Diuretics like Furosemide and Hydrochlorothiazide are commonly used by the elderly as diuretics, antihypertensives, and heart medications. Long-term use can cause adverse reactions such as fluid imbalance, electrolyte disturbances—particularly hypokalemia and hypocalcemia—which may lead to osteoporosis. Falls become highly prone to fractures under these conditions.
Proton Pump Inhibitors (PPIs) (Acid-Reducing Medications)
The U.S. Food and Drug Administration (FDA) has issued warnings that proton pump inhibitors (PPIs), such as commonly used omeprazole, may increase the risk of hip, wrist, and spinal fractures. The observed risk is most prevalent in patients over 50 years old, those taking higher doses of PPIs, or those with a history of PPI use exceeding one year.Therefore, even commonly stocked stomach-protecting medications should not be taken long-term without caution.
Antineoplastic Drugs
Many antineoplastic drugs can affect the skeletal system. For example, methotrexate reduces osteoblast activity and increases osteoclast production, leading to osteoporosis. Long-term high-dose use may even cause methotrexate osteopathy (bone pain, osteoporosis, compression fractures).Cyclophosphamide can damage osteoblasts, causing bone dysplasia and affecting bone metabolism; doxorubicin reduces the thickness of bone marrow and cortical bone by inhibiting osteoblasts. Appropriate supplementation with calcium and vitamin D preparations, especially active vitamin D, can prevent osteoporosis caused by antineoplastic drugs.