A standard test to measure how strong your bones are is done through a Bone Mineral Density test or DEXA scan. DEXA scan is a painless simple test (resembles taking X-rays). It measures the strength of your bones. There are many risk factors for increased bone loss or Osteopenia and Osteoporosis. Osteopenia is the red flag. It is a warning sign before getting osteoporosis, the more severe and serious form of bone loss. In my previous blog I listed the 12 common causes of bone loss in both men and women. Now let’s discuss the 12 medications (or groups of drugs) that may contribute to bone loss.
- Thyroid medications___ High doses of drugs used to treat thyroid disorders may increase risk of fracture. Have your TSH, T3 and T4 checked when on thyroid medication.
- Glucocorticoids (steroids)___ Steroids decrease calcium absorption and act against vitamin D. In addition, they cause more calcium to leave your body through urine. The incidence of bone fracture is related to the dose and length of therapy. Lower doses of steroids and shorter periods of therapy are less harmful than higher doses and longer courses. The relationship between glucocorticoid dose and fracture risk is complicated. That is because the disease for which these medications are being given (e.g., rheumatoid arthritis, inflammatory bowel disease) may cause bone loss and fracture. The good news is that the increased risk of fracture in patients taking glucocorticoids reduces rapidly in the first year off therapy. Examples of steroid drugs are Prednisone, Hydrocortisone
- Antidepressants ___ Observational studies have shown that both tricyclic antidepressants (TCAs) and selective serotonin reuptake inhibitors (SSRIs) can increase risk of fractures. Examples of TCAs are Amitriptyline, Nortriptyline, Imipramine, Desipramine. Examples of SSRIs include Citalopram, Fluoxetine, Paroxetine, Sertraline, Fluvoxamine
- Acid reducers___ Medications used for acid reflux can affect your bones. Some forms of calcium, such as calcium carbonate, require an acid environment for best absorption. As a result, drugs that reduce stomach acid secretion such as proton pump inhibitors (PPIs) and H2 blockers may reduce calcium absorption. Example of PPIs include Lansoprazole (Prevacid), Esomeprazole (Nexium). Common H2 blockers are Ranitidine and Famotidine. While on these drugs, you should try increasing dietary calcium and use calcium supplements that do not need acid for absorption, such as Calcium Citrate
- Seizure medications___ Some anti-epileptics (seizure drugs) affect the way Vitamin D is processed in the body and make it inactive. Low Vitamin D can cause bone loss. Long-term anti seizure therapy has been associated with low bone density and an increase in fractures. The increase in fracture rate is due to both seizure-related injuries and the adverse effects of these drugs on bone strength. Examples of these medication are Phenobarbital and Phenytoin.
- Some diabetes medications__ There is evidence suggesting that thiazolidinediones may increase risk of fractures in women (humerus, hand, foot). Examples of these drugs include Pioglitazone and Rosiglitazone
- AIDS medications— There is an increased risk of reduced bone density in human immunodeficiency virus (HIV) infected individuals. Although bone loss among patients with HIV infection is usually due to multiple reasons and not exclusively because of antiretroviral medications
- Medroxyprogesterone Acetate___ High doses of medroxyprogesterone Acetate (synthetic Progesterone) have been associated with increased bone loss. This may be due to lowering estrogen levels. High doses have been used to treat gynecologic disorders or are given for birth control in women. Try natural Progesterone instead
- Vitamin A (Beta-carotene) ___ Based upon the available bone density and fracture data, both men and women in Western countries should be cautioned against taking too much vitamin A. Common food sources of vitamin A include liver, milk, egg yolk, butter, and some fruits and vegetables; You should avoid supplements containing vitamin A If you eat plenty of these foods
- Diuretics (water pills) ___ Some diuretics increase calcium loss through urine. Examples include Furosemide and Bumetanide
- Cyclosporine___ This medication is sometimes given to treat Psoriasis, Rheumatoid Arthritis and for organ/bone marrow transplant. Animal data suggest that Cyclosporine may cause osteoporosis
- Chemotherapy drugs___ Used mainly to treat cancers, Chemotherapy drugs can have a direct negative effect on bone density. Methotrexate is an example of such drugs.
Have you had a bone density test yet? Contact your doctor to see if you should get one now. It is best to measure your bone density before or at the onset of menopause. That way you can compare the results later on to the baseline level.