Drug-induced osteoporosis is not a popular topic. Most of us believe that osteoporosis is primarily a disease of postmenopausal women. Meanwhile, the symptoms of osteoporosis may also appear in people who are constantly taking certain medications, especially those from the group of glucocorticosteroids. What medications can cause osteoporosis? What is the treatment of drug-induced osteoporosis?

Drug-induced osteoporosisis the so-callediatrogenic osteoporosis,which means that the treatment of the underlying disease causes another (osteoporosis), because the medications taken negatively affect bone metabolism. It has long been known that some groups of drugs taken chronically in various ways increase not only the risk of osteoporosis, but also the risk of injuries, falls, and thus bone fractures. This is because certain medications impair vision (cataracts), impair the nervous system (e.g. make you dizzy) or weaken your muscles (myopathy).

Drug-induced osteoporosis - causes

Drug-induced osteoporosis may result from the use of glucocorticosteroids ( steroid osteoporosis , osteoporosisafter steroids ). Due to their strong anti-inflammatory and immunosuppressive properties, glucocorticosteroids (GCs) are widely used in the treatment of many diseases. They can be replaced for a long time - GKS is administered to people suffering from various rheumatoid diseases (RA, AS), allergies and asthma, dermatoses, and even some heart diseases.

Drug-induced osteoporosis may be the result of chronic medication, e.g. from the group of gastroprotectors (proton pump inhibitors, i.e. drugs protecting the stomach against the harmful effects of various drugs on its mucosa), some antiepileptic drugs, cytostatics and others.

Drug-induced osteoporosis: most dangerous after steroids

The greatest threat to the skeletal system of patients comes from long-term use of glucocorticosteroids. In Poland, this problem concerns approx. 200 thousand. people who are treated with them chronically. The situation is similar in Great Britain (250,000 people) and the USA (1.2% of the population). In the mid-90s of the last century, attention was drawn to the adverse effect of steroid drugs on the skeletal system. It was then also found that little is being done in the world to prevent complications from developing, thoughsuch possibilities exist. GCS-induced osteoporosis develops most rapidly in the first six months of treatment. In 30-60 percent In people treated with glucocorticosteroids, the bone weakening process is very rapid during this time. Later, in the second or third year of treatment, it progresses much more slowly.

Worth knowing
  • the risk of fractures increases with the daily dose of the drug and the duration of its use
  • the lowest safe (non-osteoporotic) dose of drugs has not been determined
  • after discontinuation of treatment, the risk of fractures decreases in some patients
  • The risk of osteoporosis increases significantly in people with additional risk factors (e.g., postmenopausal women, RA, smokers)
  • bone fractures affect 30-50 percent taking GCS, despite the fact that the loss of bone mass is not too great.

This negative information about glucocorticosteroids does not, however, destroy their great therapeutic value. For many patients, they are the only solution to improve their he alth. An additional advantage of these drugs is the low price.

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Drug-induced osteoporosis: treatment and prevention

The results of many clinical trials extend the indications for the use of glucocorticosteroids. We already know the risks for the patient from chronic use of these drugs, but much more important information is that steroid-induced osteoporosis can be prevented. However, you have to be aware that the changes appearing in the bones cannot be reversed in one hundred percent.

What to do to minimize losses? Polish doctors have the ability to effectively counteract drug-induced osteoporosis, because they can recommend their patients to take a bisphosphonate - a drug that prevents bone weakness. It is reimbursed by the National He alth Fund and should be given preventively, i.e. to those who do not have osteoporosis yet, but are starting to take steroids. The next step is to take an appropriate dose of calcium and vitamin D3 and follow a proper diet.

This is especially important for young people and children treated with GSK. It is known that many serious diseases (lupus, rheumatoid arthritis, ankylosing arthritis, allergies, asthma) affect people under 30 and children. Young patients often take high doses of steroids, and the consequence of this is not only bone weakening, but also bone deformation and growth disorders - changes that cannot be reversed. That's why preventing your bones from weakening is so important. Of course, the doctor (but also the patient) should also pay attention to other diseases, to taking the medications they havenegative impact on the condition of the bones, on the diet preferred by the patient, etc. The patient, for the sake of his bones, should give up everything that contributes to their weakening, such as smoking or alcohol abuse.

Important

Are you taking medication? Control the dice!

If you are constantly taking glucocorticoids, talk to your doctor about the risk of osteoporosis. Ask about dietary supplements containing calcium and vitamin D. Ask for checkups, such as densitometry, and above all, avoid anything that may increase the risk of fractures. If you don't know if your bones are at risk, measure your height every year. If it turns out that it has lowered by 2-3 cm from the last measurement, this may be the first sign that osteoporosis is developing.

CHECK>>Osteoporosis Fracture Risk Assessment (FRAX® Calculator)

Drug-induced osteoporosis: diet and exercise

Whether we manage to slow down the rate of development of osteoporosis is also determined by our conduct. Exercise and a proper diet are very important for maintaining good bone condition. We should spend as much time as possible outdoors every day. Marches and brisk walks are irreplaceable. Let's not give up active rest, because swimming, for example, greatly increases muscle mass, and strong muscles are a great support for weak bones. In the case of osteoporosis, the scope and form of exercise should be determined with the doctor. Brittle bones are easy to break even without exercise.

Another ally of our bones is vitamin D, which is formed in the skin under the influence of sunlight. Doctors believe that judicious use of the sun, i.e. 15-20 minutes a day in summer, promotes bone he alth by ensuring the proper formation of the vitamin in the skin. For the sake of bones, we should also eat rationally (five small meals a day, rich in fruit and vegetables, dairy products, fish).

Calcium is very important in the diet: 1000-1500 mg a day is a dose appropriate for the bones of people at risk of osteoporosis. Therefore, we should eat dairy products (it is better to give milk to children, many adults do not tolerate it). It does not matter for the bones whether it will be full-fat or lean dairy (but it is important when we have to use an anti-cholesterol diet at the same time; then lean dairy is better). Bones need vitamin D to increase calcium absorption - the daily dose is 800 units.

About the authorAnna Jarosz A journalist who has been involved in popularizing he alth education for over 40 years. Winner of many competitions for journalists dealing with medicine and he alth. She received, among others Trust Award "Golden OTIS"in the "Media and He alth" category, St. Kamil awarded on the occasion of the World Day of the Sick, twice the "Crystal Pen" in the national competition for journalists promoting he alth, and many awards and distinctions in competitions for the "Medical Journalist of the Year" organized by the Polish Association of Journalists for He alth.

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Spine, bones, joints