Medications and Bone Loss
This section is to inform you about medications that can cause bone loss. If you are taking any of these medications, talk to your doctor about this possibility. Many of these medications are essential treatments for certain conditions and, in some cases, they are the best or only drug therapy available. The lifestyle changes suggested in this section of the website may help to offset the bone-thinning effects of such medications.
Glucocorticoids increase the risk of osteoporosis
One class of drugs that has been shown to have a particularly damaging effect on the skeleton are the medications referred to as glucocorticoids. A major risk factor for developing osteoporosis is long-term (more than three months continuously) use of glucocorticoid therapy such as prednisone. Glucocorticoids are produced naturally by the body as cortisol or cortisone, and are necessary for normal metabolism, growth and responding to physical stresses such as infection, injury and inflammation. Rarely, too much of this substance is produced by the body, resulting in a condition called Cushing’s syndrome, which causes many serious medical problems, including accelerated bone loss. Cushing’s syndrome used to be so rare that osteoporosis produced by an over-abundance of glucocorticoids was not considered to be a significant health problem. However, in the 1940s, synthetic glucocorticoids were introduced and have been widely used as anti-inflammatory drugs. This wide-spread use to treat a number of medical conditions has resulted in an increasing incidence of glucocorticoid-induced osteoporosis.
Glucocorticoids are taken in a number of different ways and for a variety of conditions:
-
orally in tablets or pills
-
by injection into the joints (for diseases such as arthritis)
-
by inhaler (for asthma)
-
as creams (for skin diseases)
-
as drops (for eye diseases)
-
less commonly, by intravenous injection (for multiple sclerosis or after organ transplantation).
When taken in doses above what the body normally makes, they cause bone loss. The most bone damage is likely to result from glucocorticoids taken orally, although use by other methods can also damage bone. Bone health should be carefully monitored during treatment with these drugs.
The diseases most often treated with glucocorticoid medications include:
-
Rheumatoid arthritis, lupus erythematosus, polymyalgia rheumatica, vasculitis
-
Asthma, chronic obstructive pulmonary disease, allergic rhinitis, cystic fibrosis
-
Chronic active hepatitis (liver disease)
-
Psoriasis, severe dermatitis
-
Leukemia, lymphoma and other cancers, in conjunction with chemotherapy
-
Ulcerative colitis, Crohn’s disease
-
Severe allergic reactions and inflammations
-
Multiple sclerosis (decreased mobility and vitamin D deficiency may also contribute to osteoporosis)
-
Following organ transplant, e.g., heart, kidney
-
Inflammation and diseases of the eye, e.g., glaucoma
How glucocorticoid medications affect our bones
Bone is living tissue, constantly repairing itself through a process called “remodelling,” in which the bone repairs itself to maintain its strength. Old bone is removed (resorption) and the same amount of new bone is laid down (formation). Abnormally high levels of glucocorticoids are particularly bad for bone, because they are associated with increased activity of the bone cells that break down bone, and they stop the bone-forming cells from building new bone. The result is a very rapid loss of bone. Glucocorticoids also decrease the amount of calcium that is absorbed from food and increase the loss of calcium in the urine. In addition, the production of estrogen in women and testosterone in men (both hormones protect bone) is reduced by high levels of glucocorticoids, another factor that may slow down the rebuilding of bone. The bones in the spine, ribs and wrist are the most likely to be affected by glucocorticoids.
Connect With Us