Drug-induced osteoporosis

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Osteoporosis is characterized by a decrease in bone mass, changes in the microarchitecture of bone tissue, and development of fractures with minimal trauma. Primary osteoporosis is associated with aging and decreased gonadal function, whereas secondary osteoporosis can be induced by various medications, including hormones (systemic glucocorticosteroids, aromatase inhibitors, depot-medroxyprogesterone, gonadotropin-releasing hormone agonists, levothyroxine), antisecretory (proton pump inhibitors, H2-histamine receptor antagonists), psychotropic (antiepileptic drugs, antidepressants), hypoglycemic (thiazolidinediones) agents, calcineurin inhibitors, antiretroviral drugs, anticoagulants, certain chemotherapeutic agents, loop diuretics. Medicines can lead to bone loss by interfering directly with the various stages of bone remodeling or affecting the levels of sex hormones and calcium-phosphorus metabolism. Risk factors for drug-indu- ced osteoporosis include low calcium intake, alcohol consumption, smoking, inadequate physical activity, older age, female gender, history of weight loss and/or fractures, lower weight or body mass index, postmenopause, family history of fractures. Prevention of drug-induced secondary osteoporo- sis involves the discontinuation of drugs inducing bone loss. If impossible, these medications should be used in a lower dose for a shorter time in combination with corrective therapy.

Key words

Osteoporosis, drug-induced osteoporosis, bone loss, osteoporotic fracture, drug-induced bone loss, adverse drug reaction.