Why would some medications increase the risk of osteoporosis?

To find out if a patient may be at risk of osteoporosis, there is a mechanism that allows screening: bone densitometry.

Rheumatologists indicate that in osteoporosis, in addition to loss of mass, the micro-architecture of the bone is affected. Photo: Shutterstock.

Within the framework of Reuma Expo 2022, specialists warned that different types of medicines focused on relieving ailments or other types of conditions in the body could generate an effect on the development of osteoporosis. Regarding this, Dr. Noemí Varela Rosario and Dr. Ramón Ortega Colón, members of the board of directors of the Puerto Rican Foundation for Rheumatic Diseases, called for patients to consult with their doctors about the implications and risks of certain drugs.

In the osteoporosis there is a resorption of the bone, so mass is lost that is and the body is unable to reform it in the same way. In addition to this loss of mass, the microarchitecture of the bone is affected, which gradually weakens the structure, generating fragility and possible future fractures in patients.

“We commonly see patients who have back pain and go and buy a drug or some who take antacids such as omeprazole and pantoprazole constantly, without understanding that this may be adding other risks,” said Dr. Noemí.

In that sense, Dr. Ortega explained that “when we take large amounts of the medicines that cause the acid in the stomach to dry, we can create an atrophy of the gastric mucosa and prevent the absorption of the minerals that the bone needs, generating a greater risk of osteoporosis“.

Regarding this condition, the rheumatologist also indicated that, in the case of the vertebrae, the fractures can be silent, the patient can lose mass of the vertebra and at the same time its height, in addition to having stooping over the years.

According to the Spanish Foundation of Rheumatology, the drug that is best known for its influence on bone is the glucocorticoid, but multiple bone metabolism can also be altered medicines.

Different studies indicate that the osteoporosis glucocorticoid-induced is the second leading cause of osteoporosisafter postmenopausal, and the first cause of osteoporosis secondary. It is also considered the paradigm of the osteoporosis drug induced.

It is worth mentioning that vertebral fractures are the most frequent consequence of chronic glucocorticoid administration, however, the intensity of the loss of mineral density that is It depends on the daily dose, the time of administration and the cumulative dose.

However, according to the Rheumatology Foundation, the following medicines could also play a role in the development of this condition: L-thyroxine, Heparin, Antiepileptics, Neuroleptics, Chemotherapy, Aromatase inhibitors, GnRH, Methotrexate, Cyclosporine A, Proton pump inhibitors, antidepressants: tricyclics and selective inhibitors of serotonin, lithium, loop diuretics, and thiazolidinediones.

In the case of cancer patients, the risk of suffering osteoporosis it is higher due to the effects of chemotherapy, radiotherapy, hormonal treatment and non-hormonal treatment.

Gonadotropin-releasing hormone (GnRH) analogs have an antigonadotropic effect in men and women. They are used for the treatment of prostate cancer and endometriosis and produce a rapid increase in resorption after 6–12 months of treatment. that ispredominantly trabecular bone loss and increased risk of fractures.

The American Society of Oncology recommends a fracture risk assessment and dual-source X-ray densitometry for all patients starting treatment with hypogonadism or with aromatase inhibitors.

Screening tests: bone densitometry

To find out if a patient may be at risk of osteoporosis or even suffer from it, rheumatologists have a mechanism that allows screening and seeing how fragile it is; is the densitometry that is.

In this regard, Dr. Ortega explained that this test “is usually done around menopause in the case of women, because estrogens keep the bone healthy and strong, but they decrease and estrogen is vital to maintain health that is“.

He also indicated that densitometry that is It is a simple way to measure the bone mass in the vertebra and in the hip, both in the neck of the femur, and in the total area of ​​the hip.

The follow-up that is given to the patient once it is discovered that he has a mass that is diminished, it is a preventive treatment depending on each case. “There are causes where the patient may have osteoporosis because they have certain diseases from a young age that undermine their bones, those who have inflammatory intestinal problems, who have malabsorption, alcoholism, who smoke or are extremely thin. There are different causes that must be investigated in each patient who develops osteoporosis” emphasized the rheumatologist.

After the densitometry test that isthe specialist indicated that there are some parameters established by the World Health Organization, to provide preventive treatment to the patient, according to the risk factors they have, whether they are lifestyle habits or family history.

“We have many ways to give preventive treatment. There are medicines that stop the loss of mass that isand these are the medicines most commonly used: alendronate and risedronate. There are medicines that if we see a relatively young patient who has lost mass that isstimulate bone creation and should be used early to prevent the patient from having a fragility quite severe” he added.

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