Abstract
Several classes of medications may accelerate bone loss, thereby increasing the risk of low-trauma fractures in older or younger patients with normal bone density, osteopenia, or osteoporosis. Clinicians should be aware of these possible pharmacologic causes of bone loss in order to prevent fractures, especially in patients considered to be at very high risk due to recent fractures, propensity to falls, and/or comorbidities. Glucocorticoids, aromatase inhibitors, and many other drugs administered for a variety of chronic diseases are often noted to be taken during medical visits, in both inpatient and outpatient encounters. Medical personnel should always review the reconciled medications to safeguard the bone health of patients. This chapter focuses on the most common medications that cause osteoporosis, with attention to clinical aspects and management strategies in these situations.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Buckley L, Humphrey MB. Glucocorticoid-induced osteoporosis. N Engl J Med. 2018;379(26):2547–56.
Di Dalmazi G, Vicennati V, Rinaldi E, et al. Progressively increased patterns of subclinical cortisol hypersecretion in adrenal incidentalomas differently predict major metabolic and cardiovascular outcomes: a large cross-sectional study. Eur J Endocrinol. 2012;166(4):669–77.
Chotiyarnwong P, McCloskey E. Pathogenesis of glucocorticoid-induced osteoporosis and options for treatment. Nat Rev Endocrinol. 2020;16(8):437–47.
Martineau P, Leslie WD, Johansson H, et al. In which patients does lumbar spine trabecular bone score (TBS) have the largest effect? Bone. 2018;113:161–8.
van Staa TP, Leufkens HGM, Abenhaim L, Zhang B, Cooper C. Oral corticosteroids and fracture risk: relationship to daily and cumulative doses. Rheumatology. 2000;39(12):1383–9.
de Vries F, Bracke M, Leufkens HGM, Lammers JWJ, Cooper C, van Staa TP. Fracture risk with intermittent high-dose oral glucocorticoid therapy. Arthritis Rheum. 2007;56(1):208–14.
Kanis JA, Johansson H, Oden A, McCloskey E. Guidance for the adjustment of FRAX according to the dose of glucocorticoids. Osteoporos Int. 2011;22(3):809–16.
Buckley L, Guyatt G, Fink HA, et al. 2017 American College of Rheumatology guideline for the prevention and treatment of glucocorticoid-induced osteoporosis. Arthritis Rheumatol. 2017;69(8):1521–37.
Rachner TD, Coleman R, Hadji P, Hofbauer LC. Bone health during endocrine therapy for cancer. Lancet Diabetes Endocrinol. 2018;6(11):901–10.
Chien AJ, Goss PE. Aromatase inhibitors and bone health in women with breast cancer. J Clin Oncol. 2006;24(33):5305–12.
Bedatsova L, Drake MT. The skeletal impact of cancer therapies. Br J Clin Pharmacol. 2019;85(6):1161–8.
Gnant M, Mlineritsch B, Luschin-Ebengreuth G, et al. Adjuvant endocrine therapy plus zoledronic acid in premenopausal women with early-stage breast cancer: 5-year follow-up of the ABCSG-12 bone-mineral density substudy. Lancet Oncol. 2008;9(9):840–9.
Genant HK, Cann CE, Ettinger B, Gordan GS. Quantitative computed tomography of vertebral spongiosa: a sensitive method for detecting early bone loss after oophorectomy. Ann Intern Med. 1982;97(5):699–705.
Coleman R, Hadji P, Body JJ, et al. Bone health in cancer: ESMO clinical practice guidelines. Ann Oncol. 2020;31(12):1650–63.
Burstein HJ, Lacchetti C, Griggs JJ. Adjuvant endocrine therapy for women with hormone receptor–positive breast cancer: ASCO clinical practice guideline focused update. J Oncol Pract. 2019;15(2):106–7.
Leslie WD, Morin SN, Lix LM, et al. Performance of FRAX in women with breast cancer initiating aromatase inhibitor therapy: a registry-based cohort study. J Bone Miner Res. 2019;34(8):1428–35.
Coleman R. Bisphosphonates and breast cancer – from cautious palliation to saving lives. Bone. 2020;140:115570.
Smith MR, Egerdie B, Toriz NH, et al. Denosumab in men receiving androgen-deprivation therapy for prostate cancer. N Engl J Med. 2009;361(8):745–55.
Nguyen KD, Bagheri B, Bagheri H. Drug-induced bone loss: a major safety concern in Europe. Expert Opin Drug Saf. 2018;17(10):1005–14.
Warden SJ, Robling AG, Haney EM, Turner CH, Bliziotes MM. The emerging role of serotonin (5-hydroxytryptamine) in the skeleton and its mediation of the skeletal effects of low-density lipoprotein receptor-related protein 5 (LRP5). Bone. 2010;46(1):4–12.
Neal B, Perkovic V, Mahaffey KW, et al. Canagliflozin and cardiovascular and renal events in type 2 diabetes. N Engl J Med. 2017;377(7):644–57.
Fralick M, Kim SC, Schneeweiss S, Kim D, Redelmeier DA, Patorno E. Fracture risk after initiation of use of canagliflozin: a cohort study. Ann Intern Med. 2019;170(3):155–63.
Wolf M, Rubin J, Achebe M, et al. Effects of iron isomaltoside vs. ferric carboxymaltose on hypophosphatemia in iron-deficiency anemia: two randomized clinical trials. JAMA – J Am Med Assoc. 2020;323(5):432–43.
Zaman K, Thürlimann B, Huober J, et al. Bone mineral density in breast cancer patients treated with adjuvant letrozole, tamoxifen, or sequences of letrozole and tamoxifen in the BIG 1–98 study. Ann Oncol. 2012;23(6):1474–81.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2021 The Author(s), under exclusive license to Springer Nature Switzerland AG
About this chapter
Cite this chapter
Zavatta, G., Clarke, B.L. (2021). Steroids, Aromatase Inhibitors, and Other Drugs Associated with Osteoporosis. In: Cusano, N.E. (eds) Osteoporosis. Springer, Cham. https://doi.org/10.1007/978-3-030-83951-2_4
Download citation
DOI: https://doi.org/10.1007/978-3-030-83951-2_4
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-030-83950-5
Online ISBN: 978-3-030-83951-2
eBook Packages: MedicineMedicine (R0)