Corticosteroids
Prednisone, dexamethasone, and other glucocorticoids are the biggest offenders. They're prescribed for conditions like asthma, rheumatoid arthritis, lupus, and inflammatory bowel disease. Millions of Americans take them.
The damage is fast. Bone loss begins within the first few months of use and is most rapid in the first year. Long-term corticosteroid use (more than 3 months) is the most common cause of secondary osteoporosis. These drugs suppress bone formation and increase bone resorption at the same time — a double hit.
If you're taking 5 mg or more of prednisone daily for 3 months or longer, guidelines recommend a bone density assessment.
Proton Pump Inhibitors (PPIs)
Omeprazole (Prilosec), esomeprazole (Nexium), lansoprazole (Prevacid) — these acid-reducing drugs are among the most widely used medications in the world. Many people take them for years.
PPIs reduce stomach acid, which your body needs to absorb calcium efficiently. Long-term use (one year or more) is associated with a 30-40% increased risk of hip fracture. The FDA issued a warning about this in 2010.
SSRIs (Antidepressants)
Selective serotonin reuptake inhibitors — fluoxetine (Prozac), sertraline (Zoloft), citalopram (Celexa) — affect bone metabolism through serotonin receptors found on bone cells. Studies show SSRI users have 1.5-2x the fracture risk compared to non-users. The effect appears to be dose-dependent.
Aromatase Inhibitors
Letrozole (Femara) and anastrozole (Arimidex) are used to treat hormone-receptor-positive breast cancer. They work by blocking estrogen production. Less estrogen means faster bone loss. Women on aromatase inhibitors can lose 2-3% of bone density per year — roughly triple the normal rate after menopause.
Oncologists typically recommend bone density monitoring for patients starting these drugs.
Anticonvulsants
Phenytoin (Dilantin), carbamazepine (Tegretol), and phenobarbital interfere with vitamin D metabolism. Your body needs vitamin D to absorb calcium, and without adequate calcium absorption, bones weaken. People who take anticonvulsants long-term have measurably lower bone density.
Other Medications to Watch
- Thiazolidinediones (pioglitazone, rosiglitazone) — diabetes drugs that reduce bone formation
- Androgen deprivation therapy — used for prostate cancer, causes rapid bone loss in men (see osteoporosis in men)
- Heparin — long-term use can decrease bone density
- Excess thyroid hormone — overreplacement with levothyroxine accelerates bone turnover
What to Do If You're on These Medications
Don't stop taking a prescribed medication because of bone concerns. That decision belongs to you and your doctor. But do get screened.
A baseline osteoporosis screening scan tells you where your bone density stands right now. Follow-up scans every 1-2 years track whether you're losing bone and how quickly. That data helps your doctor decide if protective measures — calcium, vitamin D, weight-bearing exercise, or bone-protective medications — are needed.
If you're on any of these medications long-term, know your bone density. Book an osteoporosis screening scan at our Rancho Mirage or San Dimas location.
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