Are Your Medications Negatively Impacting Your Bone Health?

One of the biggest health issues facing older people is bone loss. Weakening bones is caused by a number of factors, including low levels of calcium and an increasingly sedentary lifestyle. What many people do not realize is that many of the most common medications used by people over the age of 50 can also contribute to this bone loss.

Known in medical circles as medication-induced osteoporosis, this threat can also lead to an increased chance of bone fractures. The longer a patient uses some of these drugs, the higher the risk of experiencing a fracture. This makes it important to be aware of what medications are more likely to weaken your bones so that you can take the appropriate precautions. Read on for a list of the biggest culprits.

Corticosteroids

Oral corticosteroids, also known as glucocorticoids, are prescribed for a number of conditions ranging from lupus to rheumatoid arthritis to severe allergies. Specific types of corticosteroids include Prednisone, Hydrocortisone, and Methylprednisolone. This class of drugs works by lessening inflammation and reducing pain. However, the drugs also increase the rate at which bones break down.

Compounding the negative impacts, corticosteroids also reduce the body's ability to absorb calcium, another factor that increases the risk of fractures and long-term osteoporosis. Corticosteroids are the most common trigger of medication-induced osteoporosis. While younger individuals treated with this type of steroid medication may reverse any bone weakening when the treatment is stopped, people over the age of 50 may not be as lucky.

Patients on a high dose of a corticosteroid will want to monitor their bone density if it is a long-term treatment. Regular monitoring will ensure that the bone density remains at healthy levels.

Proton Pump Inhibitors

Proton pump inhibitors (PPIs) are primarily used to treat heartburn. Prescription PPIs include Omeprazole, Lansoprazole, Esomeprazole, and Pantoprazole. As they reduce stomach acid to prevent heartburn, the drugs also may mitigate the ability of the body to absorb some forms of calcium. The end result is that the body draws calcium from the bones to compensate.

Research has shown that individuals on PPIs have a greater risk of bone fractures than people who do not use this type of medication. While prescription-strength PPIs come with a warning about the risk of bone loss, this is not the case with the over-the-counter (OTC) versions. Short-term use of OTC PPIs does not carry a significant risk of bone loss. However, those with chronic reflux may want to talk to their doctor about alternative treatments.

Selective Serotonin Reuptake Inhibitors

It is more difficult to determine the relationship between the use of selective serotonin reuptake inhibitors (SSRIs) and bone density. Although SSRIs have been shown to increase serotonin levels in the brain, providing benefits to bones, the drugs may also deliver the opposite effect on serotonin in the rest of the body. The loss of this peripheral serotonin can lead to widespread bone loss.

SSRIs encompass a wide array of medications, including Fluoxetine (Prozac), Paroxetine (Paxil), Citalopram (Celexa), and Sertraline (Zoloft).

Anticonvulsant Drugs

Anticonvulsant drugs are most typically used for treating seizures; however, they can also be used to treat nerve pain, mood disorders, and migraines. This type of medication can disrupt the way that the body metabolizes vitamin D, negatively impacting overall bone health. Without sufficient levels of vitamin D, the body is not able to absorb calcium.

Some of the most common anticonvulsant drugs include Carbamazepine (Tegretol), Phenytoin (Dilantin), Primidone (Mysoline), and Phenobarbital (Luminal, Solfoton). Not all of these drugs come with the same risk to bone health, making it important to talk to your doctor about alternative medications.

Loop Diuretics

Loop diuretics are commonly prescribed to treat hypertension and edema. These conditions are typically linked to chronic kidney disease and congestive heart failure. Several studies in recent years have linked the use of loop diuretics to a higher risk of bone loss and fractures. It is believed that the increased urination when on these medications leads to calcium loss.

Compounding the issue is the research that indicates that diuretics may also amplify the threat of orthostatic hypotension. This specific type of low blood pressure increases the chance of falling when standing up suddenly, naturally raising the threat of fractures.

Furosemide (Lasix) and Bumetanide (Bumex) are the most commonly prescribed diuretics.

Anticoagulants

Lastly, anticoagulant blood thinners are believed to raise the risk of osteoporosis as they block the ability of the body to absorb vitamin K. Some types of anticoagulants also negatively affect bone health by revving up the cells in the body that break down bone tissue. This breakdown inherently chips away at bone mass.

The anticoagulants that have been linked to weakening of the bones are Warfarin and Heparin. Not all anticoagulants carry this risk, meaning that patients at risk of developing osteoporosis should explore other options with their medical care provider.

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