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Osteoporosis Secondary to MedicationAka: Drug-Induced Osteoporosis, Medication Causes of Osteoporosis

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  1. See Also
    1. Corticosteroid Associated Osteoporosis
    2. Osteoporosis Secondary Causes
    3. Osteoporosis
    4. Osteoporosis Evaluation
    5. Osteoporosis Management
  2. Causes: Anticonvulsants
    1. General
      1. Anticonvulsants accelerate bone loss in elderly by 70%
    2. Agents that increase Vitamin D and sex steroid metabolism
      1. Phenytoin (Dilantin)
      2. Phenobarbital
      3. Carbamazepine
      4. Primidone
    3. Agents that increase renal calcium excretion
      1. Valproic Acid
    4. References
      1. Ensrud (2004) Neurology 62(11):2051
  3. Causes: Endocrine and metabolic
    1. Corticosteroids (systemic and inhaled)
      1. See Corticosteroid Associated Osteoporosis
    2. Thiazolidinediones (Rosiglitazone, Pioglitazone)
      1. Odds Ratio approaches 2.5 for Glitazone use >8 months
      2. (2008) Arch Intern Med 168:820
    3. Levothyroxine at excess doses (not when TSH normal)
    4. Agents causing Hypogonadism
      1. Aromatase Inhibitors (e.g. Femara or Letrozole)
      2. GnRH agonists
      3. Parenteral Progesterone (Depo Provera)
  4. Causes: Immunosuppressants
    1. Cyclosporine
    2. Tacrolimus
    3. Methotrexate (at higher doses for longer duration due to Hypogonadism)
  5. Causes: General
    1. Heparin (prolonged use)
    2. Phenothiazines
    3. Lithium
    4. Vitamin D in excess (>2000 units per day)
    5. Vitamin A in excess (>10,000 units per day)

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