Osteoporosis is a toxic effect of long-term etretinate therapy

A double-blind, randomized, Phase III, multicenter study in 358 pediatric subjects receiving isotretinoin therapy demonstrates no effect on pediatric bone mineral density

“…Similar results have been found in other studies of pediatric subjects [2,7,8]. All The significant change in Z-scores during the study for Cip-Iso and reference product was not expected.…”

“…At least two single-center studies have described bone lucency, or osteopenia, in subjects treated with isotretinoin [5,6]. Multiple studies with similar average treatment doses to those reported in this study have not demonstrated a decrease in the lumbar spine and hip BMD using dual X-ray absorptiometry (DXA) in pediatric or adult subjects [7][8][9][10][11]. A single-center study in [17][18][19][20][21][22][23][24][25] year-old men identified no significant difference in the spine or femoral neck BMD; however, a decrease in Ward's triangle BMD was described [2].…”

Effect of a single course of isotretinoin therapy on bone mineral density in adolescent patients with severe, recalcitrant, nodular acne

“…[5][6][7]20 Another study in patients undergoing long-term therapy for various dermatoses identified osteoporosis in patients treated with etretinate but not with isotretinoin. 13 Less clear are the effects on bone when the standard doses of isotretinoin are used in acne therapy. The limited data available demonstrate that minor changes in bone structure have been observed, but that they lacked clinical significance.…”

“…9 Studies looking at changes in bone mineral density (BMD) with isotretinoin therapy have observed either no differences or minor decreases in BMD, the clinical significance of which remains unclear. [10][11][12][13] The current work reports the results obtained in a prospective study of the effect of a single course of isotretinoin therapy on BMD and on the incidence of skeletal hyperostosis in adolescents with severe, recalcitrant, nodular acne.…”

Guidelines of care for the management of psoriasis and psoriatic arthritis

“…It is characterized by degenerative spondylosis, arthritis of the vertebral articulations, and syndesmophytes of the vertebral spine, and extra spinal bones with bone spur formation. 130 Occasionally severe hyperostosis may also be induced. 131 Whether or not acitretin induces osteoporosis has been the subject of controversy, 132,133 with the risk possibly highest in those receiving high-dose retinoids for long time periods.…”