Incidence and prevalence of drug-induced osteoporosis

A recent review examines the incidence and prevalence of medication-induced osteoporosis. Whilst various medications have an adverse effect on bone metabolism, with serious clinical consequences, the authors note that the actual incidence/prevalence of clinical osteoporosis or fracture in these patients relative to drug-naïve patients is not always clear. “This is particularly important, given that the pathogenesis of disease itself may also have an effect on bone,” they write in their paper published in Current Opinion in Rheumatology. Using a systematic review of published literature the authors made the following observations: 1 - While a number of medications have been shown to induce bone loss, the actual incidence and prevalence of medication-induced osteoporosis is not well quantified. 2 - Oral corticosteroids contribute to an increased prevalence of osteoporosis and an increased incidence of fracture in a number of different populations. The increased incidence of fracture in patients receiving inhaled corticosteroids for respiratory disease may be attributed to disease pathogenesis rather than the effects of medication. 3 - Other therapies that increase the incidence and/or prevalence of medication-induced osteoporosis and fracture include androgen-deprivation therapy, aromatase inhibitors, protease inhibitors, selective serotonin reuptake inhibitors and prolactin-raising antiepileptic agents. The authors note difficulties in making definitive conclusions for a number of medications due to differences in the reporting of values and the retrospective nature of most studies, with inherent selection biases and other confounders. “Furthermore, there is little available information as to whether specific medications within a class are associated with a higher rate of bone disease than others.” The review calls for further prospective studies of drugs with known effects on bone metabolism to include clinical osteoporosis or fracture as long-term safety outcomes so that we make gain a clearer understanding of the incidence and prevalence of this condition. Reference   Allport, J. 2008, ‘Incidence and prevalence of medication-induced osteoporosis: evidence-based review.’ Current Opinion in Rheumatology, Vol. 20, pp. 435-441....