Source: O’Connell MB, Borchet JS. Osteoporosis and Osteomalacia. In: DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM, eds. Pharmacotherapy: A Pathophysiologic Approach. 10th ed. New York, NY: McGraw-Hill; 2017. http://accesspharmacy.mhmedical.com/content.aspx?bookid=1861§ionid=146068952. Accessed May 19, 2017.
Medications (Table 1)
TABLE 1.Select Medications Associated with Increased Bone Loss and/or Fracture Risk |Favorite Table|Download (.pdf) TABLE 1. Select Medications Associated with Increased Bone Loss and/or Fracture Risk
|Medications ||Comments |
|Anticonvulsant therapy (phenytoin, carbamazepine, phenobarbital, and valproic acid) ||↓ BMD and ↑ fracture risk; increased vitamin D metabolism leading to low 25(OH) vitamin D concentrations |
Antiretroviral therapy (ART)
Nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs) (zidovudine, didanosine, lamivudine, and tenofovir)
Protease inhibitors (PI) (nelfinavir, indinivir, saquinavir, ritonavir, and lopinavir)
|↓ BMD (NRTIs > PI), no fracture data; increased osteoclast activity and decreased osteoblast activity |
|Aromatase inhibitors (eg, letrozole and anastrozole) ||↓ BMD and ↑ fracture risk; reduced estrogen concentrations |
|Canagliflozin ||↓ BMD and ↑ fracture risk (FDA reviewing SLGT2 inhibitor class of medications) |
|Furosemide ||↑ fracture risk; increased calcium renal elimination |
|Glucocorticoids (long-term oral therapy) ||↓ BMD and ↑ fracture risk; increased bone resorption and decreased bone formation; dose and duration dependent; see special populations section |
|Gonadotropin-releasing hormone agonists or analogs (eg, leuprolide and goserelin) ||↓ BMD and ↑ fracture risk; decreased sex hormone production |
|Heparin (unfractionated, UFH) or low molecular weight heparin (LMWH) ||↓ BMD and ↑ fracture risk (UFH >>> LMWH) with long-term use (eg > 6 months); decreased osteoblast replication and increased osteoclast function |
|Medroxyprogesterone acetate depot administration ||↓ BMD, no fracture data; possible BMD recovery with discontinuation; decreased estrogen concentrations |
|Proton pump inhibitor therapy (long-term therapy) ||↓ BMD and ↑ fracture risk; possible calcium malabsorption secondary to acid suppression for carbonate salts |
|Selective serotonin reuptake inhibitors ||↓ BMD and ↑ fracture risk; decreased osteoblast activity |
|Thiazolidinediones (pioglitazone and rosiglitazone) ||↓ BMD and ↑ fracture risk; decreased osteoblast function |
|Thyroid—excessive supplementation ||↓ BMD and ↑ fracture risk; risk increases with TSH concentration < 0.1 mIU/L; possible increase in bone resorption |
|Vitamin A—excessive intake (> 1.5 mg of retinol form) ||↓ BMD and ↑ fracture risk; decreased osteoblast activity and increased osteoclast activity |
Men and women begin to lose bone mass starting in third or fourth decade because of reduced bone formation.
Estrogen deficiency during menopause increases osteoclast activity, increasing bone resorption more than formation....