6 Medications That Can Weaken Your Bones

Getting older. A sedentary lifestyle. Low levels of calcium. All of these are well-known risk factors for osteoporosis, a condition that causes bones to weaken and becomes more common with age. But there’s another lesser-known one that belongs on the list: certain medications.

Research shows that some of the most common medications among people 50 and over can lead to what’s known as medication-induced osteoporosis, and even an increased risk of fractures.

“Most patients and their health care providers are unaware of the additional fracture risks that common prescriptions can cause,” says Dr. Mary Beth Humphrey, a professor of medicine at the University of Oklahoma College of Medicine. “With some of these medications, the longer a patient is on them, the higher the risk of fracture, [many of which] require one or more surgeries to hold the bones together and allow healing. Preventing these fractures should be a top priority for care providers and patients alike.”

Here’s a look at six of the most common offenders.

1. Corticosteroids (a.k.a. glucocorticoids)

Oral corticosteroids — prescribed for everything from autoimmune diseases like lupus and rheumatoid arthritis to severe allergies, asthma and rashes — tamp down inflammation and reduce pain. But these meds (commonly referred to as steroids) come with an unfortunate side effect: They increase how quickly bone is broken down and interfere with the body’s ability to rebuild it. They also reduce the body’s ability to absorb calcium, all of which ups the risk of fractures and osteoporosis. In fact, they are the most common cause of medication-induced osteoporosis, and doctors say they are especially problematic for older adults.

“Young people treated with [corticosteroids] may be able to fully recover their bone strength after the steroids are stopped,” Humphrey says. “However, people over 50 have lost the ability to recover bone strength without the aid of osteoporosis therapies.”

Corticosteroids include:

• Prednisone 

• Hydrocortisone

• Methylprednisolone

What to do: If you’re on a high dose of a corticosteroid or you’ve been taking the medication for a long time — both of which make bone loss more likely — be sure your doctor regularly monitors your bone density to ensure it stays at a healthy level, suggests the American College of Rheumatology.

“It’s recommended to use the lowest effective dose for the shortest period,” Humphrey says. “If a patient is going to be on a dose of 5 milligrams or more for three or more months, it is recommended to start osteoporosis therapy to prevent bone loss.”

Humphrey also recommends talking to your doctor about whether you’re getting enough vitamin D and calcium; you may need supplements. Your provider may perform what’s known as a FRAX (fracture risk assessment tool) analysis or send you for a bone density test to determine if you’re at an increased risk for fracture.

2. Proton pump inhibitors (PPIs)

What does a common medication for heartburn have to do with bone health? In reducing stomach acid, PPIs may prevent the absorption of certain forms of calcium, so your body resorts to leaching calcium from your bones.

“The lower the bone density, the greater the fracture risk in general,” says Dr. Andrea Singer, director of bone densitometry at MedStar Georgetown University Hospital and chief medical officer of the Bone Health & Osteoporosis Foundation. Indeed, research shows a significantly higher risk of bone fractures in people who take PPIs compared with those who don’t.

Only PPIs available by prescription include a warning about the risk; not so with over-the-counter (OTC) versions. That’s likely because you aren’t supposed to take OTC PPIs for more than two weeks, which isn’t long enough to affect bone density.

Prescription PPIs include:

• Omeprazole

• Lansoprazole

• Esomeprazole

• Pantoprazole

What to do: The risk associated with PPIs is linked to long-term use. If you have chronic acid reflux, talk to your doctor about alternative treatments. Research shows, for instance, that lifestyle changes — like losing weight, quitting cigarettes and sleeping with your head elevated — can help manage symptoms.

3. Selective serotonin reuptake inhibitors (SSRIs)

The relationship between bone health and SSRIs — the most commonly prescribed class of antidepressants — is, well, complicated. While SSRIs increase serotonin in the brain, which can benefit bones, they may have the opposite effect on the vast majority of serotonin in the body, what’s known as peripheral serotonin, causing bone loss.

SSRIs include:

• Fluoxetine (Prozac)

• Paroxetine (Paxil)

• Citalopram (Celexa)

• Sertraline (Zoloft)

What to do: If you’re on an SSRI, talk to your health care provider about the potential effect of your particular antidepressant on your bone health. Depending on the severity of depression, sex, duration of use, length of SSRI treatment and other factors that can raise your risk of osteoporosis, you may be a good candidate for an alternative type of antidepressant.

4. Anticonvulsant drugs

The medications commonly used for treating seizures, and sometimes prescribed for migraines, nerve pain and mood disorders, can interfere with the way your body metabolizes vitamin D, a nutrient that has its own starring role in the health of your bones. If you aren’t getting enough vitamin D, your body can’t absorb calcium the way it should.

Anticonvulsant drugs that may weaken your bones include:

• Carbamazepine (Tegretol)

• Phenytoin (Dilantin)

• Primidone (Mysoline)

• Phenobarbital (Luminal, Solfoton)

What to do: Talk to your doctor about alternative medications since not all anticonvulsants carry the same increased risk of fracture. The older anticonvulsants are especially problematic for bone health, Singer notes, echoing research showing lower bone mineral density in patients on enzyme-inducing drugs (like those listed above) as compared with so-called noninducers.

5. Loop diuretics

These commonly prescribed water pills help treat hypertension and manage edema related to conditions like congestive heart failure and chronic kidney disease.

But a number of studies link loop diuretics to increased bone loss and an increased risk of fractures. Experts aren’t entirely sure why, but research suggests that because diuretics increase urination, they also promote calcium loss in the urine.

“When you increase calcium loss, that can affect parathyroid hormone,” potentially disrupting the usual process of bone remodeling, Singer says.  

Further complicating matters: Diuretics may also play a role in exacerbating orthostatic hypotension, a type of low blood pressure that creates dizziness when standing up, leading to an increased likelihood of falls and subsequent fractures. 

Diuretics that may weaken your bones include:

• Furosemide (Lasix)

• Bumetanide (Bumex)

What to do: “There may be some relationship between dose and duration of use, so longer-term use could potentially be problematic,” Singer says.

If you are required to take diuretics over the long term, talk to your doctor about whether thiazide diuretics (Microzide, Esidrix) make sense for you. Research suggests that thiazides may have a positive effect on bone mineral density. 

6. Anticoagulants

Although the research is inconclusive, blood thinners (like warfarin) are believed to increase the risk of osteoporosis because they block vitamin K, which is crucial for bone health. Other blood thinners (such as heparin) impact bone health by stimulating certain cells in the body that are responsible for breaking down bone tissue, leading to a loss of bone mass.

Anticoagulants that may weaken your bones include:

• Warfarin

• Heparin

What to do: Not all anticoagulants pose the same potential risk for fractures, and the risk becomes more of an issue with prolonged use (more than a year), Singer says.

Depending on your overall health and the condition you’re treating, you may be able to switch to one of the blood thinners known as direct oral anticoagulants (DOACs). DOACs — such as apixaban (Eliquis), dabigatran (Pradaxa), rivaroxaban (Xarelto) and edoxaban (Savaysa) — don’t carry the same risk for osteoporosis as heparin and warfarin, but they may not be right for everyone. Your doctor can explain the risks and benefits.