Certain Medications Increase Risk for Osteoporosis and Spinal Fractures

Medications can be lifesavers when it comes to the treatment of various conditions. But they can also open the door to other serious conditions. Medications fall into pharmacological drug classes. Certain medications can interfere with bone health, and induce bone density loss. Users of these medications could put them at risk for osteoporosis and possible spinal fracture/s. Medications that can potentially weaken bones and how to protect yourself is the focus. Not all of the medications listed are for treating spinal disorders or neck and back pain.  

Steroids

Steroids taken by mouth are commonly prescribed for spinal conditions. This includes:

• Low back pain
• Neck pain
• Spinal inflammatory arthritis

These medications carry anti-inflammatory compounds that are pretty powerful. These help the pain but can cause bone loss with long-term use. These types of steroids put the bones at risk because of how they slow down the osteoblasts, which are bone-building cells. As the osteoblasts are slowed, the work of the osteoclasts, which are bone-absorbing cells gets increased straining the system and ultimately leading to bone loss.

Examples of steroids:

• Dexamethasone
• Methylprednisolone
• Prednisone

Daily doses of more than 5 mg pose the biggest threat to the skeletal system. Ask a doctor about a short-term low-dose regimen, especially, if there is a heightened risk for osteoporosis or spinal fracture.

Selective Serotonin Receptor Uptake Inhibitor

Selective serotonin receptor uptake inhibitors help those with neck and low back pain in a variety of ways. These include reducing the mental and emotional effects of chronic pain. But, selective serotonin receptor uptake inhibitors can boost the fracture risk. This type of medication can cause bone loss in older women and reduced bone density in men and children.

Examples of selective serotonin receptor uptake inhibitors:

• Fluoxetine
• Paroxetine
• Sertraline

Ask a doctor for another type of selective serotonin receptor uptake inhibitor. Possibilities include serotonin and norepinephrine reuptake inhibitors, that can achieve the same results without bone loss and fracture risks.

Certain Anticonvulsants

Anticonvulsants are used to control seizures. However, they have been found to help individuals with spinal nerve pain. But there are some types of anticonvulsants that can increase the liver’s vitamin D metabolism. This lowers the blood’s vitamin D levels. Vitamin D is essential to the body’s ability to absorb calcium. That means that lower vitamin D levels can cause bone loss.

Examples of anticonvulsants:

• Phenytoin
• Phenobarbital
• Valproic acid

Talk to a doctor, chiropractor, or health coach about taking a vitamin D supplement/s to boost vitamin D levels.

Certain Diabetic Medications

There are two types of diabetic medications that can increase the risk of fracture. Thiazolidinediones known as TZD’s and sodium-glucose cotransporter 2 inhibitors. The TZD’s increase the fat cells in the bone marrow, and lower the bone-building cells. The sodium-glucose cotransporter 2 inhibitors can reduce bone density.

Examples of TZD’s:

• Pioglitazone
• Rosiglitazone

If there is a high risk of fracture, ask a doctor if an alternative medication to a TZD can be taken.

Examples of sodium-glucose cotransporter 2 inhibitors:

• Canagliflozin
• Dapagliflozin
• Empagliflozin

If there is a greater risk of falls, ask a doctor if an alternative to taking a sodium-glucose cotransporter 2 inhibitor can be taken.

Hormone Medications

Medications that reduce estrogen or androgen levels in the body also increase the bone’s absorbing cell activity. And this can lead to bone density loss.

Examples of hormone medications:

• Anastrozole
• Exemestane
• Leuprolide
• Goserelin
• Medroxyprogesterone acetate

If there is an increased risk for osteoporosis or fracture, talk to a doctor about ways to protect the bones while taking these medications.

Antacids

Antacids both over-the-counter and prescription that contain aluminum help to neutralize stomach acid. There are other medications called H2-blockers also known as proton-pump inhibitors. These reduce how much acid the stomach produces. While these aid in reducing heartburn, stomach pain, etc, long-term use can reduce the body’s ability to absorb calcium and thus increase the risk for fracture.

Examples of these types of antacids:

• Aluminum hydroxide
• Magnesium hydroxide

Examples of Proton-Pump Inhibitors:

• Omeprazole
• Esomeprazole
• Lansoprazole

Ask a doctor if a different H2-blocker can achieve the same results. Additionally, a doctor, nutritionist, or health coach could recommend dietary changes/adjustments to help reduce stomach acid.

Blood Thinners and Anticoagulants

These medications help reduce the risk of stroke, can interfere with the body’s ability to absorb calcium. They reduce the activity of the bone-building cells. This causes bone loss and increases the risk of fracture.

Examples of anticoagulants or blood thinners:

• Enoxaparin sodium
• Warfarin

Talk to a doctor about a possible alternative anticoagulant. A change in medication has been shown to put the bones at less risk.

Diuretics

Loop diuretics work by reducing inflammation/swelling along with water retention by increasing the kidneys urine production. These medications can cause the kidneys to remove key nutrients like calcium, potassium, and magnesium to help increase bone production. Reduction in all of these increases the risk of bone loss and a spinal fracture.

Examples of loop diuretics:

• Furosemide
• Ethacrynic acid
• Bumetanide

Talk to a doctor about an alternative known as a thiazide diuretic. These encourage the kidneys to retain calcium, thus increasing bone density.

Reduce The Risk

Protecting bone health is the objective. A bone mineral density test could help along with taking bone-boosting supplements. Learning about the risks of taking these medications can help prevent osteoporosis and spinal fractures. Keep track of all medications over-the-counter, prescription, holistic, all-natural, etc, and make sure all doctors, specialists understand what is being taken. A spine specialist or endocrinologist might not what the other doctor has prescribed, so keep everyone informed.

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Dr. Alex Jimenez’s Blog Post Disclaimer

The scope of our information is limited to chiropractic, musculoskeletal, physical medicines, wellness, and sensitive health issues and/or functional medicine articles, topics, and discussions. We use functional health & wellness protocols to treat and support care for injuries or disorders of the musculoskeletal system. Our posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate and support directly or indirectly our clinical scope of practice.* Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We also make copies of supporting research studies available to the board and or the public upon request. We understand that we cover matters that require an additional explanation as to how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900. The provider(s) Licensed in Texas& New Mexico*