Medication-Induced Bone Loss
The most commonly prescribed medications strip bones of minerals, damage collagen, and increase the risk of osteoporosis, falls, and fractures.1 Not all drugs increase a person’s risks equally. It can depend on the dose, your age, how long you take it, and whether you’re on multiple medications.
This is a dangerous and essential issue that everyone needs to be aware of. I’ve lectured at medical conferences to educate physicians on this topic, and it is also included in a chapter in my book, Fracture-Proof Your Bones. Consult your doctor and pharmacist if you are taking any medications, especially those listed below. This is not an all-inclusive list.
Acid blockers
Androgen-deprivation therapy (ADT)
Antidepressants (specifically those that increase serotonin)
Antipsychotics
Aromatase inhibitors
Blood pressure medications
Chemotherapy
Depot medroxyprogesterone acetate (DMPA)
Glucocorticoids
Heparin
Hypnotics (e.g., for anxiety and sleep
Immunosuppressants
Muscle relaxants
Opioids
Acid Blockers
In 2010, the FDA warned about taking acid-blocking medications and fracture risk.2 Taking a PPI for one year is associated with a 22% increase in hip fracture risk, which climbs each year: 41% after two years, 54% after three years, and 59% after four years.3
Antidepressants
Serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs)—are prescribed for depression, anxiety, fibromyalgia, premenstrual syndrome, and more. Patients taking SSRIs have a 67% increased risk of fractures. These medications are so harmful that one person is expected to break a bone for every 85 people taking the drug for one year. After five years, one will fracture for every 19 patients taking an SSRI .18 It’s not just the SSRIs that damage bone. A ten-year study of 6,645 Canadians concluded that SSRIs and SNRIs are both associated with an increased fracture risk.19
Antiseizure medications
Osteoporosis affects up to 31% of people with epilepsy, and people taking antiseizure medications are two to six times more likely to break a bone compared to people not taking these drugs.20 Importantly, not all epilepsy medications seem to cause bone loss and osteoporosis. Although data are limited, research suggests that Lamictal (lamotrigine) does not appear to harm bones or increase the risk of fractures.23 However, valproate can, but only when taken for 36 months or longer.24
Aromatase Inhibitors
Aromatase inhibitors (AIs) block estrogen production and are one of the top-prescribed drugs for postmenopausal women with estrogen receptor-positive (ER-positive) cancers.25,26 Once a woman starts an AI, it’s common for her to continue taking it for many years. Bone loss in women with breast cancer is a major concern. Up to 80% of all breast cancer patients lose bone.27,28 Plus, breast cancer patients who are hospitalized with a fracture have an 83% higher risk of dying compared to breast cancer patients who don’t break a bone.29
Glucocorticoids
Glucocorticoids, such as prednisone, suppress inflammation and modulate the immune system. Fractures occur in up to 50% of patients who take them for an extended period.39 Even taking less than 2.5 mg/day for six months increases fracture risk up to 200% compared to people not taking them.40
High Blood Pressure Meds
Maintaining healthy blood pressure is essential for cardiovascular health. If one of these medications decreases your blood pressure too much, it can create dizziness and imbalance. This increases your risk of falls and fractures. Making sure you’re on the proper dose is essential for safely taking these drugs. If you’re taking any blood pressure medication, regularly monitor your blood pressure and ensure it is within the target range set by your doctor.
Hypnotics
Hypnotics, like zolpidem (Ambien), eszopiclone (Lunesta), and lorazepam, are typically prescribed for difficulty sleeping, anxiety, and panic. While they help people feel calmer and sleep better, they also decrease alertness and can cause dizziness and lightheadedness the next day. Additionally, they can increase the risk of accidents and falls and have been associated with other health issues.48,49 A systematic review and meta-analysis of data from eighteen studies with patients 72 to 84 years old concluded that taking any of these medications increased fracture risk by up to 240% compared to people not taking them.51
Muscle relaxants
Like hypnotics, opioids, and antihypertensive medications, muscle relaxants increase the risk of falls and fractures, especially in older adults.52 A review of Medicare Advantage patient data concluded that taking a muscle relaxant was associated with a 40% increased risk of fracture compared to individuals not taking one.54
What You Can Do
Here are some tips on how to protect and maintain strong bones.
Get a bone density test: Individuals taking any of these medications should consult their doctor about undergoing a bone density test to screen for potential bone loss.
Dietary supplements: Testing vitamin D and taking a vitamin D and calcium dietary supplement are also commonly recommended. A form of vitamin K2, specifically MK4, has been demonstrated in clinical trials to support healthy bone density and maintain strong bones, even in individuals taking certain medications. Clinical trials have shown more significant improvements in bone density when people combine MK4 (45 mg/day) with Vitamin D rather than taking them separately.
Diet: A plant-forward, Mediterranean Diet is associated with improved bone health and a 21% lower risk of fractures.
Exercise: Engaging in regular exercise to improve stability, mobility, and strength can help keep you safer.
For more information and tips, consult Fracture-Proof Your Bones: A Comprehensive Guide to Osteoporosis. It covers important topics, provides essential questions to ask your doctor, and helps you create a comprehensive bone health plan to keep you safe.
Dr. John Neustadt, ND, is the Founder and President of Nutritional Biochemistry, Inc. (NBI) and NBI Pharmaceuticals. He is the host of the Delivering Health podcast, wrote four books, including Fracture-Proof Your Bones: A Comprehensive Guide to Osteoporosis, worked with the FDA on evaluating the use of natural products for the potential treatment of rare diseases, and is on the Bone Health and Osteoporosis Foundation Corporate Advisory Roundtable. He’s been recognized as one of the Top 10 Cited Authors in the world for his work and frequently teaches about bone health and other topics at medical conferences and on podcasts.