Drugs That Cause Bone Softening (Osteoporosis)

By Dr Harold Gunatillake - Health Writer

There are some drugs given for specific illnesses, but they may have the side effect of softening the bones on long term use. If it is used short term for a few weeks, or if you are asked to take on and off, the damage to the bones is less likely.

 Cortisones
 These drugs are prescribed by doctors for rheumatoid arthritis, asthma, and other chronic diseases. They are helpful in alleviating diseases but softening of bones is most likely on long term medication. It is important to weigh the pros and cons: the benefits of the medicine against the effect on the bones.

These drugs seem to inhibit bone formation and also increase bone resorption, thus causing fractures after mild falls.

Cortisones though given to treat allergies, they also could cause allergies. The symptoms would be – vision problems, severe depression, unusual thoughts or behaviour, convulsions, swelling of the body, rapid weight gain, feeling short of breath, passing blood or tarry stools due to upper bowel bleeding, and so on.

Milder symptoms are nausea, stomach pains, increased sweating, slow wound healing, acne and so on.

 Anti-Cancer Drugs
 These drugs too can affect the health of bones. Some ladies after breast surgery for cancer are given drugs called aromatase inhibitors. Some of them are anastrozole (Arimidex), exemestane (Aromasin), and letrozole (Femara)
These drugs target a substance the body makes called aromatase. Inhibiting the action of this chemical produces less oestrogen in the hormone glands, like the ovaries. Some breast cancers are hormone dependant, and giving these inhibiting drugs can control further spread and arrest secondary growths in the body, elsewhere.

Lowering oestrogen levels can lead to resorption of bone cells. Doctors do prescribe to improve the lifestyle- exercises, a diet rich in calcium and vitamin D.

Prostate cancer
Men having prostate cancer are sometimes prescribed anti-androgen therapy to reduce the manufacture of the male hormone – testosterone. Diminishing levels of the hormone may arrest further spread of the cancer in the prostate.  Examples of these drugs include bicalutamide (Casodex), flutamide (Eulexin), and nilutamide (Nilandron).

These drugs inhibit the action of testosterone, slowing the cancer growth. These medications too, can decrease bone density and increase the incidence of fracture risk. They are also advised lifestyle changes, including stopping of smoking, and reducing coffee intake.

 Antidepressant Drugs
 Some drugs used for chronic depression, called SSRIs, may affect your bones. Examples of this drug are – citalopram (Celexa), fluoxetine (Prozac), paroxetine (Paxil), and sertraline (Zoloft).
People taking these medications are prone to fractures of bones.

One study, for instance, found those currently taking the SSRI antidepressants were more than twice as likely to have a fracture not in their spine than those not taking an SSRI. Another study of women with a history of depression showed lower bone density in those who had taken SSRIs than those who didn’t take the drugs.

 Drugs taken for GERD
 GERD stands for gastroeosophageal reflux disease).This is quite a common disease today mainly induced by spicy acidic rich foods. Gastric acid seem to reflux through the gullet as far as the throat. Some complain of a sore throat than heart burn. On closer questioning it makes clear that the throat irritation is due to acid reflux.

The drugs that are given for GERD are – esomeprazole (Nexium), lanssssoprazole (Prevacid) and omeprazole (Prilosec, Zegerid).

In 2010, the FDA warned that taking high doses of PPIs for a long time may make fractures of the hip, wrist, and spine more likely. The FDA ordered a labeling change on the medicines to note the risk.
There are other drugs given for GERD that are bone friendly.

Cimetidine (Tagamet), famotidine (Calmicid, Mylanta) and ranitidine (Zantac).

iabetic drugs
 Diabetic medications, such as pioglitazone (Actos) and rosiglitazone (Avanda) may cause bone softening.

 Bone friendly drugs-bisphosphonate
 Drugs given for osteoporosis may cause uncommon fractures, when given long term. These drugs are alendronate (Binosto, Fosamax), ibandronate (Boniva), risedronate (Actonel, Atelvia), and zoledronic acid (Resiast).
Other risk factors for osteopororsis are sedentary life, low intake of calcium and vitamin D, smoking, excessive alcohol intake, family history, over active thyroid or taking thyroid tablets.

 Coffee intake
 Coffee intake is not considered a significant risk factor for osteoporosis. But there has been concern about coffee’s impact on bone strength because coffee can impair absorption of calcium from the digestive tract. This probably matters most when coffee intake is high (e.g., four or more cups of coffee daily) and calcium intake are low.

It is possible that people who smoke cigarettes also tend to drink lots of coffee; one might conclude that coffee intake increased osteoporosis risk in a particular group of people when it was really the smoking.

Also, big coffee drinkers may drink less milk than people who don’t like coffee. In fact, several studies found that the possible negative effects of coffee consumption on bone strength were mostly limited to people with low calcium intake and that the problem could be overcome by increased calcium intake.

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