Rheumatology Book

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Osteoporosis Secondary to Medication

Aka: Osteoporosis Secondary to Medication, Drug-Induced Osteoporosis, Medication Causes of Osteoporosis
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  1. See Also
    1. Corticosteroid Associated Osteoporosis
    2. Osteoporosis Secondary Causes
    3. Osteoporosis
    4. Osteoporosis Evaluation
    5. Osteoporosis Management
  2. Causes: Anticonvulsants
    1. General
      1. Anticonvulsants accelerate bone loss in elderly by 70%
    2. Agents that increase Vitamin D and sex steroid metabolism
      1. Phenytoin (Dilantin)
      2. Phenobarbital
      3. Carbamazepine
      4. Primidone
    3. Agents that increase renal calcium excretion
      1. Valproic Acid
    4. References
      1. Ensrud (2004) Neurology 62(11):2051-7
  3. Causes: Endocrine and metabolic
    1. Corticosteroids (systemic and inhaled)
      1. See Corticosteroid Associated Osteoporosis
    2. Thiazolidinediones (Rosiglitazone, Pioglitazone)
      1. Odds Ratio approaches 2.5 for Glitazone use >8 months
      2. (2008) Arch Intern Med 168:820-5
    3. Levothyroxine at excess doses (not when TSH normal)
    4. Agents causing Hypogonadism
      1. Aromatase Inhibitors (e.g. Femara or Letrozole)
      2. GnRH agonists
      3. Parenteral Progesterone (Depo Provera)
  4. Causes: Immunosuppressants
    1. Cyclosporine
    2. Tacrolimus
    3. Methotrexate (at higher doses for longer duration due to Hypogonadism)
  5. Causes: General
    1. Antiretrovirals (HIV Infection)
    2. Heparin (prolonged use)
    3. Phenothiazines
    4. Lithium
    5. Vitamin D in excess (>2000 units per day)
    6. Vitamin A in excess (>10,000 units per day)

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