Do Your Medications Affect Your Bones?
Antidepressant Drugs and Bone Health
Some drugs used to treat depression, known as SSRIs, may affect your bones. Examples of SSRIs include:
- citalopram (Celexa)
- fluoxetine (Prozac)
- paroxetine (Paxil)
- sertraline (Zoloft)
That's not to say you shouldn't take them. When weighing risks and benefits, Kearns says to remember that depression itself has been linked with poor bone health.
However, most studies looking at the effects of SSRIs on bone health have found a greater chance of fractures in people taking drugs, Kearns says.
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.
Kearns' advice: Ask your doctor each time they refill the antidepressant prescription: "Is this still the right drug?" "Is this the right dose?" Make sure the doctor prescribing your antidepressant knows about your bone health concerns, and consider asking about how much calcium and vitamin D you need.
GERD Drugs and Bone Health
If you have GERD (gastroesophageal reflux disease), your stomach acid backs up into your esophagus. You may be taking a type of drug called a proton pump inhibitor (PPI), which may or may not require a prescription. PPIs include:
- esomeprazole (Nexium)
- lansoprazole (Prevacid)
- omeprazole (Prilosec, Zegerid)
Over-the-counter PPIs include versions of Prevacid 24HR, Prilosec OTC, and Zegerid OTC.
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.
Other drugs, called H2 blockers, curb the production of stomach acid. H2 blockers include:
- cimetidine (Tagamet)
- famotidine (Calmicid, Fluxid, Mylanta AR, Pepcid)
- ranitidine (Tritec, Zantac)
These drugs may be more bone-friendly, according to Kearns, but that's not certain yet.
Diabetes Drugs and Your Bones
Research about the effect of some diabetes drugs on bone health has been accumulating, says Chad Deal, MD, head of the Center for Osteoporosis and Metabolic Bone Diseases at the Cleveland Clinic.
Many recent studies have shown that a kind of diabetes drugs known as thiazolidinediones have a negative effect on the bones, according to Deal and Kearns. Examples of these drugs include:
- pioglitazone (Actos)
- rosiglitazone (Avandia)
There are other types of diabetes drugs, so that may be something for you and your doctor to consider when you're going over all your medications.
Bisphosphonates are a type of osteoporosis drug. They include:
- alendronate (Binosto, Fosamax)
- ibandronate (Boniva)
- risedronate (Actonel, Atelvia)
- zoledronic acid (Reclast)
Some studies linked their long-term use to a greater chance of an uncommon fracture of the thigh bone.
If someone who's been taking a bisphosphonate for a long time has that rare type of thigh bone fracture, their doctor should switch them to another type of osteoporosis drug, Deal says.
The following drugs are among the alternatives to bisphosphonates for either treating or preventing osteoporosis:
- calcitonin (Miacalcin)
- denosumab (Prolia). This is a biologic drug that slows bone loss.
- raloxifene (Evista)
- teriparatide (Forteo). This is a type of parathyroid hormone that increases bone formation.
- Hormone replacement therapy
If you've been taking a bisphosphonate for five years, Deal says your doctor may check to see whether you should continue, stop, or switch to another bone-maintenance drug.