Many common medications have deleterious effects on bone, driving the surge in osteoporosis-related fractures. Listed below are some of the most problematic drug classes. Be judicious in prescribing them, especially to at-risk patients.
Oral glucocorticoids: Long-term use of glucocorticoids (< 2.5 mg/day for 6 months or more) is associated with a 20% to 200% increased risk of vertebral fractures. For each 10 mg increase in dose, there is a 62% increase in risk for bone fracture. The good news is that fracture risk normalizes after cessation of the medication (Van Staa TP, et al. J Bone Miner Res. June 2000;15(6):993-1000; Van Staa TP, et al. Arthritis Rheum. Nov 2003;48(11):3224-3229).
Anti-Ulcer Drugs: Over time, proton pump inhibitors like Prilosec, Prevacid, Nexium, Protonix, Aciphex can really compromise bone strength. A nested, case control study of 13,556 people with hip fractures and 135,386 controls showed a steady increase in relative risk of fracture associated with duration of PPI use.
The risk was increased by 22% with 1 year of treatment; by the 3rd year it was up to 54%. After 4 years, it was up to 59%. The risk was stronger for men than women (p = 0.04), and it was dose-dependent. A similar risk profile is seen with H2 blockers like Zantac (Yang YX, et al. JAMA. 2006; 296(24): 2947-2953).
Antibiotics: Because much of an individual’s total vitamin K is made by or converted by gut bacteria, it is highly susceptible to disruption by antibiotics. Use of broad spectrum antibiotics can inhibit vitamin K production by gut flora, diminishing it by as much as 75% (Conly J, Stein K. Clin Invest Med. 1994; 17(6): 531-539). Be aware of this phenomenon when prescribing antibiotics to patients at high-risk of osteoporosis, and use these drugs very selectively.