Following a fracture, a physician must review all medications for potential contribution to bone fragility 

The majority of older individuals who sustain a fragility fracture have recently taken prescription drugs that are associated with an increased fracture risk—and a similar percentage continue to receive these agents after the fracture, suggest results of a recent study that highlights a missed opportunity to reduce secondary fractures.– Melinda B. Tanzola, PhD in The Puzzling Use of Drugs that Increase Fracture Risk

About one in two women and one in four men over age fifty will break an osteoporotic bone. Some of us won’t be surprised: We know our bone mineral is meager or our bones are overly stiff; others, many times men, don’t know until the fracture. So would you be surprised to find that following an osteoporotic fissure, few physicians review medications to see whether any in the armory of the patient’s pumps or pills is known to cause osteoporosis? That’s exactly what Sarah D. Berry and her Harvard Colleague Douglas P. Kiel found to be the case and the consequences of the lapse cannot be overstated: to cite just two shocking facts, the incidence of osteoporotic fracture is greater than heart attack, stroke and breast cancer combined; and, among those who fracture a hip 21% will die in the first year.

Dr. Berry says that a fracture patient’s physician should review three groups of medicines:

  • drugs that increase fall risk, which include antidepressants, benzodiazepines and sleeping pills (e.g., zolpidem or Ambien)
  • drugs that decrease bone density, principally though not only proton pump inhibitors, long known to the medical community (though rarely communicated to the public) as cause of osteoporosis and prednisone, a potent anti-inflammatory drug which WebMD reports as prescribed for many and varied conditions such as arthritis, blood disorders, breathing problems, severe allergies, skin diseases, cancer, eye problems, and immune system disorders. Prednisone belongs to a class of drugs known as corticosteroids. While steroids except those applied to the skin are considered osteoporosis risk, even in small doses prednisone is a known osteoporosis risk.
  • drugs with unclear fracture risk mechanism

Ideally, always confirm with your physician that there is no herbal, dietary, environmental or activity alternative to drugs that have a known causal link to osteoporosis. This is essential if you suffer a fragility fracture.

Reference

Medication Review After a Fracture – Absolutely Essential
Sarah D. Berry MD/MPH and Douglas P. Kiel MD/MPH
JAMA Internal Medicine October 2016 Volume 176. Number 10

Invited Comment for
Patterns of Prescription Drug Use Before and After Fragility Fracture
Jeffrey C. Munson, MD, Julie P. W. Bynum et al JAMA Intern Med. 2016;176(10):1531-1538.

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