Osteoporosis Secondary to Medication

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

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II. 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):2051-7 [PubMed]

III. 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 168:820-5 [PubMed]
  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)
  5. Other hormonal agents
    1. Depo-Medroxyprogesterone (Depo-Provera)

IV. Causes: Immunosuppressants

  1. Cyclosporine
  2. Tacrolimus
  3. Methotrexate (at higher doses for longer duration due to Hypogonadism)

V. Causes: General

  1. Loop Diuretics (decreased renal Calcium absorption)
  2. Proton Pump Inhibitors (decreased Calcium absorption)
  3. Selective Serotonin Reuptake Inhibitors
    1. Rizzoli (2012) Bone 51(3):606-13 +PMID:22659406 [PubMed]
  4. Antiretrovirals (HIV Infection)
  5. Heparin (prolonged use)
  6. Phenothiazines
  7. Lithium
  8. Vitamin D in excess (>2000 units per day)
  9. Vitamin A in excess (>10,000 IU or >250 mcg per day)

VI. References

  1. Jeremiah (2015) Am Fam Physician 92(4): 261-8 [PubMed]

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