Are you in the habit of reading your drug information sheet and the list of side effects when you receive your prescription? Do you listen to the list of drug side effects in drug commercials? Undoubtedly, the list of adverse effects is long and even surprising.
Drug-induced osteoporosis and increased risk of fractures are side effects from many commonly used prescribed and over-the-counter medications. These unintended consequences can cause significant disruption to your health or worse. Are you or a loved one at increased risk?
Drugs Affect Normal Bone Health
America is a nation of pill poppers. About 7 out of 10 individuals take prescription drugs. Inside your medicine cabinet, you likely may have one or more medications that affect your bone density. Numerous drugs cause bone loss and/or impair hormones, nutrients and other mechanisms for bone repair that increase the risk for fractures. Other drugs cause issues with balance, dizziness, and sedation that affect your stability and ability to walk; even leading to falls and fractures.
Review articles such as those published in the Mayo Clinic Proceedings and European Journal of Endocrinology, and numerous other medical journals have a identified several categories of drugs that lead to osteoporosis and/or increased fracture risk. Read on to learn more!
Drugs That Cause Bone Loss and/or Increase Risk of Fracture
Acid Blocking Drugs (Antacids, H2 blockers, and Proton Pump Inhibitors):
Common antacids include Maalox, Mylanta, Tums, Rolaids, Alka Seltzer, and Milk of Magnesia or the generic equivalent which contain aluminum hydroxide, magnesium hydroxide suspension, and/or calcium carbonate.
H2 blockers include cimetidine (Tagamet), ranitidine (Zantac), famotidine (Pepcid), nizatidine (Axid).
Proton pump inhibitors include omeprazole (Prilosec), lansoprazole (Prevacid), esomeprazole magnesium (Nexium).
These include heparin, Coumarin, Coumadin
SSRIs: common examples include fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), and others.
MAOIs: selegiline (Emsam, Deprenyl).
Atypical antipsychotics such as olanzapine (Zyprexa), risperidone (Risperdal), blonanserin (Lonasen), etc.
Tricyclic antidepressants (TCAs): imipramine (Tofranil), amitriptyline (Elavil), nortriptyline, protriptyline, desipramine, doxepin, and trimipramine.
Examples include nucleoside/nucleotide reverse transcriptase inhibitor (NRTI)-containing regimen (zidovudine-lamivudine combination, lamivudine-abacavir combination, and abacavir alone) and protease inhibitor (PI)-containing regimen (lopinavir-ritonavir combination, ritonavir, and atazanavir).
Common medications include phenytoin (Dilantin), phenobarbital (Luminal), and valproate sodium (Depacon).
Aromatase Inhibitors (AIs):
Commonly prescribed AIs include (Aromasin) exemestane, (Arimidex) anastrozole, and (Femara) letrozole. These drugs are commonly used for several years at a time in cancer therapy to inhibit estrogen. Chronic use of AIs has been shown to cause persistent bone loss and increased fracture risk.
Commonly prescribed examples include diazepam (Valium), triazolam (Halcion), alprazolam (Xanax), chlordiazepoxide (Librium) and many more.
Examples include cyclosporine (Sandimmune, Neoral, Cicloral, Gengraf, Deximune), tacrolimus (Prograf, Advagraf, and Protopic) and cyclosporine ophthalmic (Restasis). These drugs are used to suppress the immune system and also may be used to treat dry eye syndrome.
Loop diuretic, i.e., Lasix/furosemide.
Common examples include Prednisone, prednisolone, triamcinolone (Kenalog), dexamethasone (Dexamethasone) and may be oral, inhalant, and long-acting steroid injections. Topical steroid applications generally have a low risk.
Glucocorticoids also interfere with vitamin D and calcium metabolism amongst other factors that cause bone loss.
Insulin Sensitizers and Type 2 Anti-Diabetic Drugs:
Common examples include thiazolidinediones (TZD)(aka, glitazones), e.g., rosiglitazone (Avandia), pioglitazone (Actos) and troglitazone.
Sex Hormone Agents:
Gonadotrpin-releasing Hormone Agonists (GnRH) and androgen deprivation therapy (ADT), These drugs are used to decrease sex hormones in hormone sensitive cancers and other hormone disorders. Commonly prescribed medications include leuprolide (Lupron, Eligard), buserelin (Suprefact, Suprecur), and deslorelin (Suprelorin, Ovuplant).
Synthetic versions of estrogen, progesterone, or a combination lead to several nutrient deficiencies, increase pro-inflammatory compounds and excess estrogens that interfere with bone density.
Examples include desogestrel and ethinyl estradiol (Apri), drospirenone and ethinyl estradiol (Yaz, Yasmin), norethindrone and ethinyl estradiol (Ortho-Novum), norgestrel and ethinyl estradiol (Low-Ogestrel), Camila, Errin, Heather, Jolivette, Nora-BE, Depo-Provera (medroxyprogesterone) and Mirena.
Morphine and opiates (fentanyl, methadone, oxycodone, tramadol, codeine, and others are associated with increased fracture risk. This is likely related to their effects on the brain causing dizziness as well as disruption of various hormones that affect bone remodeling and repair.
Acetominophen/Tylenol and NSAIDs also increase the risk for fractures. NSAIDs include ibuprofen (Advil), naproxen (Aleve), and high dose aspirin. Prescription NSAIDs include extra-strength versions of ibuprofen and naproxen, also diclofenac, celecoxib and COX-2 selective inhibitors, such as valdecoxib (Bextra), celecoxib (Celebrex), and rofecoxib (Vioxx).
Frequent use of these medications interferes with the natural resolution of inflammation. Chronic unresolved inflammation from anywhere in the body causes osteoclasts to work overtime. Osteoclasts break down old bone. Bone building cells (osteoblasts) cannot keep up with pace of osteoclasts and bone loss ensues.
Excess intake or improperly prescribed thyroid hormone. Examples include Thyroid desiccated (Armour Thyroid), levothyroxine (Levoxyl, Synthroid, Unithroid).
This is not an exhaustive list of drugs known to interfere with bone density or increases risk of fracture. Check with your health care practitioner and/or pharmacist for more information.
If you are on a drug that increases bone loss and/or fracture risk, work with your medical practitioner to use the lowest dose possible for the shortest amount of time or find an alternative drug. If you must be on a medication that causes loss of bone density, be diligent about your bone health in ways that you can control.
Factors that Support Healthy Bones
Bone health depends on many factors. Physical activity, frame size, ethnicity, childhood nutrition, healthy gut flora, digestion and absorption, leptin and insulin homeostasis, management of stress and cortisol levels, reduction/avoidance of sugar, processed food, soda pop, caffeine, gluten intolerance and Celiac disease, and more affect bone health. Both sexes experience bone loss. Women commonly experience bone loss earlier in life than men. You can modify many of these risk factors. More information may be found in the “Health Topics” section.
Do You Have Strong, Healthy Bones?
Your tolerance to these medications is greatly affected by how well you have managed the health of your bones over time. If you drank soda pop or sugar sweetened beverages frequently in your youth, ate a poor diet with large amounts of sugar, caffeine with a sedentary lifestyle, the quality of your bones is compromised.
Then, what about years of use of ibuprofen or Tylenol, birth control pills, acid blocking drugs, or an anti-depressant? Bone health is further compromised, and your risks greatly increase. What does your future hold? How about your children, an elderly relative or friend using one or more of these medications?
Basic Support for Bones
Bones are in a constant state of rebuilding and remodeling throughout your lifetime. You can help your bone rebuild with weight bearing exercise and a whole foods diet.
Consume a well-balanced diet, preferably organic. Enjoy 5-13 servings per day of fruits and vegetables of all different colors, with protein, beans, legumes, seeds, nuts, and unrefined grains - preferably gluten-free. Reduce or avoid things that challenge your body or provoke inflammation. Be diligent about safety, especially with things that can cause slips and falls.
Nutrients for Bones
Dietary supplementation for bone health provides additional support beyond your daily diet. It is easy to fall short on nutrient intake. Poor appetite, fad diets, poorly planned meals, stress eating, restricted diets, and drug-nutrient depletions, etc. also compromise your nutrient intake.
Nutrients required for bone health include calcium, magnesium, vitamin D, vitamin K2, B vitamins, protein, glycosaminoglycans/glucosamine, collagen, zinc, copper, iron, silica, boron, selenium and sulfur. Plant-based antioxidants and inflammation modulating nutrients are also fundamental to bone health. These include boswellia, turmeric, quercetin, ginger, resveratrol, and others.
Strive also for optimal intake of at least 2 grams/day of omega-3 fish oils DHA and EPA. These oils support many aspects of bone health along with inflammation management, brain, heart, immune, gut, skin, and cell membrane health, etc.
No one wants to experience that sudden slip and fall or snap and fall that leads to one or more broken bones and the complications that can arise. Be diligent and proactive about your health. Read your drug side effect information. Anything that you do to help your bones with diet, lifestyle, and nutrition will have benefits for your whole body. Healthy bones do a body good!