Update on Medications With Adverse Skeletal Effects

Abstract

Patients rely on their primary care physician to manage multiple, often chronic medical conditions that require prescription medications. Balancing the risk to benefit of treatments can be challenging and requires that the primary care physician stay abreast of new information regarding risks and benefits. The number of medications with reported adverse effects on skeletal health is expanding. This review focuses on medications recently added to the list of "bad to the bone" drugs and on recent advances in management of glucocorticoid-induced osteoporosis. A practical approach to assessing and managing the skeletal risks is outlined.Mayo Clin Proc. 2011;86(4):338-343 BMD = bone mineral density; GnRH = gonadotropin-releasing hormone; 5HTT = 5-hydroxytryptamine transporter; PPARγ = peroxisome proliferator-activated receptor gamma; PPI = proton pump inhibitor; SSRI = selective serotonin reuptake inhibitor; TCA = tricyclic antidepressant © 2011 Mayo Foundation for Medical Education and ResearchOn completion of this article, you should be able to (1) identify prescription medications associated with increased risk of fractures, (2) recognize the importance of assessing baseline fracture risk in patients initiating and continuing these medications, and (3) recognize the role of teriparatide in patients at high risk of fracture who must take glucocorticoids.

Osteoporoza prouzrokovana lekovima

“…Gubitak koštane mase najveći je u početku prelaznog doba i iznosi 5% gubitka gustine godišnje. Visok rizik za nastanak osteoporoze nose mnogi predilekcioni faktori, način života i brojne bolesti [3][4][5] kao što su:…”

“…Poznato je da glukokortikoidi, hormoni štitaste žlezde i antiepileptici mogu izazvati osteoporpzu, ali novija istraživanja ukazuju na to da i drugi lekovi, neočekivano, poput inhibitora protonske pumpe, antivirusnih lekova, diuretika, antidepresora i dr. mogu smanjiti gustinu i narušiti strukturu kostiju [4][5][6].…”

“…Gubitak koštane mase jedno je od neželjenih dejstava ovih lekova, čak i kada se primenjuju u malim dozama [4][5][6]8]. Ovo zaslužuje posebnu pažnju u svetlu podataka da se oni danas često propisuju u terapiji [7].…”

“…Duža primena mogla bi biti povezana sa smanjenjem nivoa estrogena i gubitkom koštane mase kuka i kičme [4,5] Merenje koštane gustine svakih 6 meseci kod žena starosti 14-30 godina koje su uzimale 12-24 meseci etinil-estradiol bilo kontinuirano ili u diskontinuitetu, pokazalo je povezanost ovih lekova i smanjenja gustine skeleta. Zbog toga se ženama koje uzimaju ove preparate preporučuje kao preventiva dovoljan dnevni unos kalcijuma i vitamina D i adekvetne fizičke vežbe [4,5,23].…”

Effect of Quercetin on Bone Mineral Status and Markers of Bone Turnover in Retinoic Acid-Induced Osteoporosis

“…Ageing, estrogen defi ciency and oxidative stress are the contributing factors resulting into osteoporotic bone. In addition, certain medications increase the rate of bone loss [Pitts & Kearns, 2011].…”