Drug-induced bone loss: a major safety concern in Europe

Abstract

Drug-induced bone loss remains the major cause of vertebral and hip fractures and significantly associated to morbidity and mortality. This article will review the common drugs identified as the causes of bone loss and the risk factors and management in European countries. Areas covered: Beyond glucorticoid - the most cause of osteoporosis, many different drugs could cause harmful skeletal disorders. The antiepileptics, hormonal therapy, GnRH antagonists, aromatase inhibitors are well-known cause of bone loss. Osteoporosis and fractures risk also increased with calcineurin inhibitors, antiretroviral drugs, selective inhibitors of serotonin reuptake, loop diuretics, heparins, oral anticoagulants, high doses of thyroxine and proton pump inhibitors. Expert opinion: Drugs are an important secondary cause of osteoporosis. Healthcare professionals should reassess the requirement for drugs and use the lowest dosage and shortest duration. Lifestyle changes, adequate calcium, vitamin D supplement, appropriate monitoring of bone status and initiating osteoporosis treatment if indicated are recommended when drugs having potential deleterious effects on bone are used, particularly in high risk patients. The update and further studies would provide concluded evidences of controversial drugs induced bone loss and determine the best prevention and treatment strategies.

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Promoting bone health in children and adolescents following solid organ transplantation

“…Prolonged GC use is associated with avascular necrosis and slipped capital epiphysis as well as fractures of vertebrae, ribs, and the ends of long bones, consistent with more severe effects at trabecular as compared to cortical sites 18 . A number of other medications that may adversely affect bone may be used in children and adolescents post‐transplantation and should also be avoided or minimized, when possible 19 . (Table 1).…”

“…18 A number of other medications that may adversely affect bone may be used in children and adolescents post-transplantation and should also be avoided or minimized, when possible. 19 (Table 1).…”

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