Drug induced osteoporosis

Abstract

Background: Osteoporosis, that denotes the bone porosity, is the disease, when the bone mineral density (BMD) is decreased. Bones become porous and fragile, that increase the risk of bone fractures. Bone mass loss develops slowly and progressively. Fractures often develop with no symptoms. According to the WHO criteria, osteoporosis is defined as a BMD that lies 2.5 standard deviations or more below the average value for young healthy women (a T-score of ≤ -2.5 SD).Bone cell elements are represented with osteoblasts, osteoclasts, osteocytes and lining cells of small quantity. Osteoblasts are the bone forming cells. Their major functions are the bone matrix synthesis and its  following mineralisation. Vitamin D and calcium also participate in the process of mineralisation. Osteoclasts are the bone resorbtion cells. Their main function is the breakdown of old bone and its  resorption by lysosomal enzymes. Osteocytes are formed from osteoblasts and promote the maintenance of bone matrix. These cells regulate the activity of modeling and remodeling processes. Osteoporosis represents the result of disbalance of breakdown and synthesis.

Method: 200 million new cases of osteoporosis are diagnosed worldwide and this disease causes 8.9 million fractures each year.

It is well known fact for physicians that osteoporosis is associated with age, life style (tobacco, alcohol, caffeine) and postmenopausal state. At the same time epidemiological studies reported that many widely used medications were the reason of decrease of the bone mineral density and increase of the fracture risk.

Results: It is important to know that risk of osteoporosis is increased by use of glucocorticoids, antidepressants, antiepileptic drugs,  aromatase inhibitors,  gonadotropin-releasing hormone agonists, androgen deprivation therapy, thiazolidinediones, anticoagulants, calcineurin inhibitors,  medroxyprogesterone acetate and proton pump inhibitors.

Discussion: It must be noted that combination therapy with above mentioned groups of medications is often used that in turn increases the harmful influence on bone tissue. Physicians must foresee the side effects of these groups and monitor the bone mineral density during their long administration and prevent and treat the drug induced  osteoporosis, as indicated.