Medication and Bone Density: What You Need to Know
If you take medications for asthma, rheumatoid arthritis, depression or GERD, you might be at greater risk for osteoporosis.
There’s a good reason doctors want to know if their older female patients take medication for asthma, rheumatoid arthritis, depression or gastroesophageal reflux disease (GERD), says Stephen Honig, MD, director of the Osteoporosis Center at NYU Langone Medical Center, and clinical associate professor of medicine at NYU School of Medicine. Certain drugs that treat these conditions may put patients at greater risk for osteoporosis.
Risk: Doctors often treat asthma and other lung diseases with prednisone, a glucocorticoid, which is a steroid. “Prednisone and other glucocorticoids affect the how the body breaks down and rebuilds bone” says Honig. “This class of drugs increase bone loss by increasing the activity of osteoclasts, and decrease bone formation by decreasing the activity of osteoblasts.”
Counteract Risk: To maintain bone health, most doctors will try to minimize the amount of a patient’s prednisone intake and rely instead on steroid-free drugs to control inflammation.
“Inhaled steroids are safer for bones, so bronchodilators can reduce the amount of steroids needed to control the underlying lung disease,” he says.
Risk: Steroids—especially prednisone—are also often used in the treatment of rheumatoid arthritis and other chronic inflammatory conditions. But, as research has shown, long-term use of steroids—three months or more—can contribute to bone loss and lead to fractures.
Counteract Risk: For patients who need to be on long-term anti-inflammatory medication, doctors will often substitute other drugs to minimize—or even eliminate—the use of prednisone.
Risk: SSRIs—selective serotonin reuptake inhibitors—are a class of drugs widely used to treat depression. However, Honig points out that recent animal research suggests that serotonin may block bone formation. Because of these new findings, it’s possible that any drug that increases the amount of serotonin in the system—as the SSRIs do—may reduce bone formation. “There’s good evidence that these drugs could contribute to bone loss and increase the chance of fracture,” he says.
Counteract Risk: Physicians may use other classes of drugs to treat depression.
Risk: Proton pump inhibitors (PPIs) are often used to treat gastroesophageal reflux disease, better known as GERD. When a person has GERD, stomach contents—food or stomach acid—get pushed back into the esophagus, and may cause heartburn or other symptoms. PPIs can help reduce the amount of stomach acid, thereby helping to relieve the symptoms of reflux and gastritis, says Honig. However, he says, some experts believe that a certain amount of stomach acid is necessary to effectively absorb calcium, a necessary mineral for bone health. Some research has shown that at very high doses, PPIs may be associated with lower bone mass and a possible increase in fracture rate.
Counteract Risk: “We recommend patients get as much calcium as they can from their diets,” says Honig. “When patients do need calcium supplementation, we suggest calcium citrate, which is absorbed independently of the acid content in the stomach.” Calcium carbonate, a popular form of calcium, requires stomach acid for optimal absorption.
Ideally patients will become more aware of the connection between certain drugs and osteoporosis. Honig suggests patients review all their medications with their doctors.
Although older women are more vulnerable to developing osteoporosis, others need to be vigilant about their bone health when taking prednisone. “Prednisone is the leading cause of drug-related osteoporosis, so even younger patients who take more than 7.5 mgs of prednisone daily for inflammatory conditions are advised to use the lowest effective dose possible,” says Honig.