Some Medications May Harm Your Bones

Certain drugs increase your risk for osteoporosis or spinal fracture—What you need to know.

Medications can be a double-edged sword—they can be vital when it comes to treatment of a specific condition, but they can introduce other problems. For example, did you know that several drug classes can interfere with bone health, such as bone mineral density? If you’re a long-term user of one of the medications below, you may be putting yourself at risk for osteoporosis and/or spinal fracture.

This article describes drugs that are potentially bad for your bones and how you can protect yourself. While not all the medications listed treat spine disorders or neck and back pain, you may take one or more of these drugs for other medical conditions.
Multi-colored pills, with x-ray images in the background.Oral steroids put your bones at risk because they slow down your osteoblasts (bone-building cells). Photo Source:

Oral Steroids

How steroids harm bones: Oral steroids (which are taken by mouth) are commonly prescribed for spinal conditions, including low back pain, neck pain, and spinal inflammatory arthritis. These drugs contain powerful anti-inflammatory medication, which may help ease pain but can cause bone loss with long-term use. Oral steroids put your bones at risk because they slow down your osteoblasts (bone-building cells), while increasing the work of osteoclasts (bone-absorbing cells).

Examples of steroids that may harm bones:

  • Methylprednisolone (Medrol)
  • Prednisone (Deltasone)
  • Dexamethasone (Decadron)

The key takeaway for bone health: Daily doses of more than 5 mg pose the biggest threat to your bones. Ask your doctor about a short-term and/or low-dose regimen, particularly if you are at a heightened risk for osteoporosis or spinal fracture.

Selective Serotonin Receptor Uptake Inhibitor (SSRI) Antidepressants

How SSRIs harm bones: SSRIs help people with neck and low back pain in many ways, including reducing the mental and emotional toll of chronic pain. However, SSRIs may boost your fracture risk. Additionally, this type of antidepressant may cause bone loss in older women, and reduced bone density in children and men.

Examples of SSRIs that may harm bones:

  • Fluoxetine (Prozac)
  • Paroxetine (Paxil)
  • Sertraline (Zoloft)

The key takeaway for bone health: Ask your doctor if another type of antidepressant, such as a serotonin and norepinephrine reuptake inhibitor (SNRI), will achieve the same results without the bone risks.

Certain Anticonvulsant Drugs

How some anticonvulsants harm bones: Anticonvulsants are typically used to control seizures, but they can also help people with spine-related nerve pain. However, some types of anticonvulsants can increase your liver’s vitamin D metabolism, which lowers your blood’s vitamin D levels. Vitamin D is essential to your body’s ability to absorb calcium, so lower vitamin D levels can cause bone loss.

Examples of anticonvulsants that may harm bones:

  • Phenytoin (Dilantin)
  • Phenobarbital (Luminal)
  • Valproic acid (Depakote)

The key takeaway for bone health: Talk to your doctor about taking a vitamin D supplement to boost your vitamin D levels.

Certain Diabetes Drugs

How some diabetes drugs harm bones: Two types of diabetes medications—thiazolidinediones (TZDs) and sodium-glucose cotransporter 2 (SGLT2) inhibitors—may increase your fracture risk. TZDs boost the fat cells in your bone marrow and lower your bone-building cells, while SGLT-2 inhibitors may reduce your bone density.

Examples of TZDs that may harm bones:

  • Pioglitazone (Actos)
  • Rosiglitazone (Avandia)

Examples of SGLT-2 inhibitors that may harm bones:

  • Canagliflozin (Invokana)
  • Dapagliflozin (Forxiga)
  • Empagliflozin (Jardiance)

The key takeaway for bone health: If you have a higher risk of breaking a bone, ask your doctor if you can use a drug alternative to a TZD. If you have a higher risk of falls, ask your doctor if you can avoid using a SGLT-2 inhibitor.

Hormone Drugs

How some hormone drugs harm bones: Drugs that reduce the level of estrogens or androgens in your body also increase bone-absorbing cell activity, which leads to bone loss.

Examples of hormone drugs that may harm bones:

  • Anastrozole (Arimidex)
  • Exemestane (Aromasin)
  • Leuprolide (Lupron Depot)
  • Goserelin (Zoladex)
  • Medroxyprogesterone acetate (Depo-Provera)

The key takeaway for bone health: If you are at risk for osteoporosis or fracture, talk to your doctor about what you can do to protect your bones while taking these drugs.

Antacids and Proton Pump Inhibitors

How these stomach drugs harm bones: Aluminum-containing antacids (both over-the-counter and prescription) help neutralize stomach acid. Similarly, drugs called H2-blockers or proton-pump inhibitors (PPIs) reduce the acid the stomach produces. While these 2 drugs may reduce stomach pain, long-term use may reduce your body’s ability to absorb calcium and increase your fracture risk.

Examples of aluminum-containing antacids that may harm bones:

  • Aluminum hydroxide, magnesium hydroxide (Maalox, Mylanta)

Examples of PPIs that may harm bones:

  • Omeprazole (Prilosec)
  • Esomeprazole (Nexium)
  • Lansoprazole (Prevacid)

The key takeaway for bone health: Instead of a PPI, ask your doctor if a different H2-blocker may achieve the same results. Also, talk to your doctor about dietary adjustments to help reduce stomach acid.

Blood Thinners and Anticoagulants

How these stroke drugs harm bones: These medications, which help reduce stroke risk, can interfere with your body’s ability to absorb calcium. They can also reduce the activity of your bone-building cells, which causes bone loss and heightened fracture risk.

Examples of anticoagulants or blood thinners that may harm bones:

  • Enoxaparin sodium (Lovenox)
  • Warfarin (Coumadin, Jantoven)

The key takeaway for bone health: Talk to your doctor about the possibility of prescribing a newer anticoagulant, which have been shown to put your bones at less risk.

Loop Diuretics

How these diuretics can harm bones: Loop diuretics reduce swelling and water retention by increasing the kidneys’ urine production. These drugs also cause the kidneys to remove other bone-boosting nutrients, like calcium, potassium and magnesium, which increases bone loss and spinal fracture risk.

Examples of loop diuretics that may harm bones:

  • Furosemide (Lasix)
  • Ethacrynic acid (Edecrin)
  • Bumetanide (Bumex)

The key takeaway for bone health: Talk to your doctor about switching to a thiazide diuretic. Thiazide diuretics encourage the kidney to retain calcium, which increases bone density.

Taking Any of These Drugs? Here’s How to Help Curb Your Bone Risk

If you’re taking any of these drugs, it’s important to work with your doctor and take extra steps to protect your bone health. Consider having a bone mineral density test and taking supplementing with bone-boosting nutrients. Investing the extra time to learn about your risk may help prevent osteoporosis and painful spinal fractures down the road.

Another very important tip: Keep track of all your medications (both over-the-counter and prescription) and make sure all your doctors understand what you’re taking. A spine doctor and endocrinologist may not be aware of what the other is prescribing, so do your part to keep everyone informed.

Updated on: 09/09/19
Continue Reading
Oral Steroids and Back Pain
Continue Reading:

Oral Steroids and Back Pain

Oral steroids, or corticosteroids such as prednisone taken by mouth, are prescription anti-inflammatory medications that may be prescribed to treat low back pain or neck pain. Be sure to discuss potentially serious side effects with your doctor.
Read More