Medications, Smoking and Osteoporosis

There are several medication (in fact quite a large number of medicines) used in clinical practice for treatment of different ailments have potential effect on bones and as a result have potential of causing osteoporosis and other medical problems related to bone. In the groups of medications with potential risk of bone problem the glucocorticoids are at the top of the list, which can be regarded as the commonest medication to cause osteoporosis. Sometimes it may not be possible to determine the exact extent to which glucocorticoid (s) are responsible for causation of osteoporosis, because use of glucocorticoids in primary disease may itself be responsible for osteoporosis, such as when glucocorticoids used in treatment of rheumatoid arthritis. Other medications have less risk of causing osteoporosis, in compare to glucocorticoids.

Prolonged use of high dose of thyroid hormone (thyroxine) can cause bone remodeling and as a result in bone loss and osteoporosis. Anticonvulsant drugs also increase the risk of osteoporosis, may be by causing deficiency of vitamin-D [1,25(OH)2D], which occurs due to induction of the cytochrome P450 system and vitamin D metabolism.

Patient undergoing organ transplantation are also at high risk of osteoporosis (due to rapid bone loss) and fracture due to combined use of glucocorticoids and immunosuppressant drugs (cyclosporine, tacrolimus etc.) and hepatic or renal failure (risk factors of osteoporosis).

Drugs which can block the aromatase enzyme (aromatase inhibitors), which converts androgens and other adrenal precursors to estrogen, can reduce circulating estrogen levels dramatically, especially among postmenopausal women. Aromatase inhibitors are used in breast cancer treatment (in various stages of breast cancer), have a detrimental effect on bone density, osteoporosis and risk of fracture.

The following drugs are associated with increased risk of osteoporosis among adults:

  • Glucocorticoids
  • High dose of thyroxine
  • Immunosuppressants (cyclosporine)
  • Anticonvulsants
  • Aromatase inhibitors
  • Chronic alcoholism.
  • Heparin
  • Lithium
  • Cytotoxic drugs
  • Aluminum.

Smoking/Cigarettes and Osteoporosis:

Smoking cigarettes (especially chronic smoking for several years), negative effect on bone mass, which may be due to toxic effects on osteoblasts (direct effect), or indirectly by modifying estrogen metabolism. Cigarette smokers (females) reach menopause 1-2 years earlier than non smokers, which can contribute to higher osteoporosis and fracture among smoker females.

Smoking also causes respiratory and other illnesses, frailty, poor nutrition, and the need for additional medications such as glucocorticoids for lung disease and contribute to osteoporosis. Smokers also tend to live sedentary life which itself is a risk factor for osteoporosis.

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2 Comments

  • CNA Salary August 30, 2010 09.45 pm

    Keep posting stuff like this i really like it

    Reply 
  • hunter rain boots
    August 4, 2011 - 11:00 pm

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