Do Your Medications Affect Your Bones?

From the WebMD Archives

If you have osteoporosis, or are at risk for it, you want to do all you can to keep your bones as strong as possible. Besides following your doctor's advice on diet and exercise, you should know that some medications are bone-friendly -- and others may have side effects that affect the bones.

Some medications prescribed for common health problems, such as heartburn or depression, could affect your bone health.

"That doesn't necessarily mean you should stop them," says Harold Rosen, MD, director of the Osteoporosis Prevention and Treatment Center at Beth Israel Deaconess Medical Center in Boston.

Rather, "it's crucial to weigh the pros and cons: the benefits of the medicine against the effect on the bones," he says.

The benefits of a drug may outweigh the risks. Or your doctor may prescribe a ''bone-maintenance" drug to offset the risk, Rosen says.

Corticosteroid Drugs and Bone Health

This type of steroid drug helps curb inflammation. Doctors prescribe them for conditions including rheumatoid arthritis, asthma, and ulcerative colitis.

Some examples include:

These steroids hamper bone formation and increase bone resorption, which can make a fracture more likely, notes endocrinologist Ann Kearns, MD, a consultant at the Mayo Clinic in Rochester, Minn.

However, she says, some people need these drugs. And the ''short-term risk is not a big deal for most people," Rosen says.

How you take the drugs may also matter. Pills or shots are the most powerful, but those you inhale or put on your skin are "less concerning," Kearns says.

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Anti-Cancer Drugs and Bone Health

If you've had breast cancer and are taking certain drugs that affect your bones, your doctor should monitor your bone density and may prescribe a bone-maintenance drug.

Some breast cancer patients take a type of drug called an aromatase inhibitor. These drugs include:

These drugs target a substance your body makes called aromatase. That leads to lower estrogen levels, which can dim estrogen-fueled cancers.

That's good news for your cancer, but lowering your estrogen levels can be bad for your bones, since estrogen stops bone resorption. That's why doctors often prescribe improved lifestyle changes such as exercise, a diet rich in calcium and vitamin D, and bone-maintenance drugs to women who are taking the aromatase inhibitors.

Men who have been treated for prostate cancer are sometimes prescribed anti-androgen therapy. Examples of these drugs include bicalutamide (Casodex), flutamide (Eulexin), and nilutamide (Nilandron).

These drugs block the action of the hormone testosterone, usually slowing prostate cancer growth. However, these medications can decrease bones' density and increase fracture risk, so doctors may prescribe changes in lifestyle such as exercise, smoking cessation, reduced caffeine intake, and a bone-maintenance drug.

Antidepressant Drugs and Bone Health

Some drugs used to treat depression, known as SSRIs, may affect your bones. Examples of SSRIs include:

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.

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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:

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:

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:

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.

Bone-Maintenance Drugs

Bisphosphonates are a type of osteoporosis drug. They include:

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:

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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.

Hormone replacement therapy (HRT) -- either estrogen alone or a combination of estrogen and progestin -- used to be prescribed for the prevention and treatment of osteoporosis. The drug Duavee (estrogen and bazedoxifene) is a type of HRT approved to treat menopause-related hot flashes. Duavee may also prevent osteoporosis in high-risk women who have already tried non-estrogen treatment.

Research has shown that hormone replacement therapy increases the risk of breast cancer , heart disease, and stroke in some women. So while HRT is known to help preserve bone and prevent fractures, it isn't generally recommended at this point for treating osteoporosis because the health risks are thought to outweigh the benefits.

In women who have been on menopausal hormone therapy in the past and then stopped taking it, the bones begin to thin again -- at the same pace as during menopause.

WebMD Feature Reviewed by Brunilda Nazario, MD on January 10, 2013

Sources

SOURCES:

Harold Rosen, MD, assistant professor of medicine, Harvard Medical School; director, Osteoporosis Prevention and Treatment Center, Beth Israel Deaconess Medical Center, Boston.

Ann Kearns, MD, PhD, consultant in endocrinology, Mayo Clinic, Rochester.

Pitts, C. Mayo Clinic Proceedings, April 2011.

FDA: "Possible Fracture Risk with High Dose, Long-term Use of Proton Pump Inhibitors."

Bazelier, M. Pharmacoepidemiology and Drug Safety, published online March 6, 2012.

National Osteoporosis Foundation: "Medicines That May Cause Bone Loss."

Chad Deal, MD, head, center for Osteoporosis and Metabolic Bone Disease, Cleveland Clinic.

American Cancer Society: "Medicines to Reduce Breast Cancer Risk."

National Osteoporosis Foundation: "Medicines Approved to Prevent and/or Treat Osteoporosis."

American Cancer Society: "Hormone (androgen deprivation) therapy for prostate cancer.''

Khalili H. BMJ, Jan. 30, 2012.

National Osteoporosis Foundation: "Managing & Treating Osteoporosis: Factors to Consider When Choosing a Treatment."

News release, FDA.

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