Drug-Induced Disorders of Bone Metabolism
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- Jones, G. & Sambrook, P.N. Drug-Safety (1994) 10: 480. doi:10.2165/00002018-199410060-00006
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Calcium homestasis depends upon the interplay of intertinal calcium absorption, renal excretion and skleletal mobilistion of calcium, mediated through bone formation and resorption, which are closely coupled in the adult skeleton. Serum calcium is extremely important for maintanance of normal cellular function and is regulated by the major calciotropic hormones, parathyroid hormone (PTH), 1, 25-dihydrxy-vitamin D and calcitone. Certain drugs can interfere with calcium metabolism by effects at different stages in calcium metabolism, and a knowledge of the mechanism of drug action is generally helpful in understanding the varius resultant clinical skeletal syndromes. Corticosteroids, for example, have profound effects at multiple stages of calcium metabolism, resulting in decreased bone formation and enhanced bone resorption leading to accelerated osteoporosis. Drugs such as aluminium and anticonvulsants impair mineralisation, leading to osteoporosis. Other drugs, such as fluoride, are employed for their known effects on bone, but in excess dosage can be harmful by producing mineralisation defects. Management of these conditions will be discussed in this review.