Know your risk.
Some medications can lead to bone loss or weakening if they're used in high doses over a long time frame. This bone loss -- or osteoporosis -- increases the risk for fractures, which can be painful and disabling, according to the National Osteoporosis Foundation. "Patients should ask their health care providers about their risk for osteoporosis and fractures," says Dr. Andrea Singer, clinical director for the National Osteoporosis Foundation and a bone specialist at MedStar Georgetown University Hospital. Here's a look at some medications that could lead to bone loss:
Glucocorticoids or corticosteroids
Oral and intravenous forms of glucocorticoids or corticosteroids, including cortisone, dexamethasone, methylprednisolone and prednisone, are used to treat asthma, rheumatoid arthritis, Crohn's disease, lupus, allergies, cancer and autoimmune conditions. Singer says the risk for osteoporosis depends on duration and strength of the medicine. For example, taking steroid medicines at 5 mg or more for three months or longer can increase the risk for bone loss and osteoporosis, she says. If you're concerned, talk to your doctor about a bone density test, says Dr. Nelson Watts, a spokesman with the Endocrine Society and director of Mercy Health Physicians' osteoporosis and bone health services in Cincinnati.
Drugs used to treat thyroid disorders should be carefully monitored, says Dr. Joseph Lane, orthopedic surgeon at the Hospital for Special Surgery, professor of orthopedic surgery at Weill Cornell Medical College in New York City and a spokesman for the American Academy of Orthopaedic Surgeons. People with hypothyroidism whose medications are managed properly usually don't encounter problems. However, people on higher doses for thyroid cancer may have an increased risk for bone loss. Gonadotropin-releasing hormone agonists -- medications that mimic the body's ability to boost hormone levels -- are frequently used to treat endometriosis, prostate cancer or female infertility and may pose an increased risk for bone loss.
Epilepsy -- a common, chronic neurological disease -- can have life-threatening outcomes if left untreated, but medicines used to treat it, such as phenytoin and phenobarbital, can cause bone loss, Singer says. The risk for such a side effect varies per person. Patients taking anti-seizure medications should never hesitate to ask their doctor about the best ways they can improve their bone health while being treated for epilepsy or other conditions, Watts says.
Selective serotonin re-uptake inhibitors -- or SSRIs -- are a class of antidepressants used to treat major depressive disorder and anxiety disorders. They include fluoxetine, sertraline, citalopram, paroxetine, escitalopram, dapoxetine, mesembrine, seproxetine and zimelidine. Research doesn't show what dose or length of treatment is necessary to increase risk. "If somebody is on those medications, if nothing else, it's an alert for people to think about bone health," Singer says. "And ask their health care provider, 'Might I be at risk? Should I be evaluated, and what can I do to minimize that risk?'"
Other drugs shown to cause bone loss include: antacids that contain aluminum for heartburn; chemotherapy drugs; cyclosporine and tacrolimus used for the prevention of organ transplant rejection; heparin for blood clot prevention; loop diuretics such as furosemide and torsemide to treat heart failure; edema and some kidney problems; medroxyprogesterone acetate for contraception; methotrexate for cancer and rheumatoid arthritis; and thiazolidinediones -- or TZDs -- such as pioglitazone or rosiglitazone used to treat diabetes.
Minimize your risk.
Getting enough calcium from food sources is key, Watts says: "For those who fall short, a modest calcium supplement would be desirable." The National Osteoporosis Foundation recommends the following: Women 50 and younger should get 1,000 mg of calcium from all sources daily, and women 51 and older need 1,200 mg. The NOF suggests men 70 and younger take 1,000 mg of calcium daily, while those 71 and up should take 1,200 mg. In addition to calcium, most adults under 50 need 400 to 800 international units of vitamin D daily, and most adults 50 and older need 800 to 1,000 IU daily, according to the foundation.