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Many medications can reduce bone density, especially with long-term use. Those most at risk are older adults, post-menopausal women, people on high-dose therapy and those with low calcium/vitamin D intake.
- Corticosteroids (most common)
Used for asthma, arthritis, autoimmune diseases
Effect: Decreases calcium absorption, increases bone breakdown.
Risk: Even moderate doses over a few months can cause bone loss.
Examples: Prednisone, Dexamethasone
- Hormone-related therapies
A: Aromatase inhibitors, used for breast cancer
Effect: Lowers oestrogen which accelerates bone loss.
Examples: Anastrozole, Letrozole
B: Androgen deprivation therapy, used for prostate cancer
Effect: Reduces testosterone which weakens bone.
- Anti-seizure medication
Effect: Interferes with vitamin D metabolism.
Examples: Phenytoin, Carbamazepine
- Heparin (long-term use)
Effect: Increases bone breakdown.
- Excess thyroid hormone
Effects: High levels increase bone turnover.
Example: Levothyroxine (when over-replaced)
- Reflux/Gastroesophageal Reflux Disease (GERD)
Effect: May reduce calcium absorption with long-term use.
Examples: Omeprazole, Esomeprazole
- Antidepressants
Effect: Decreases bone density, unclear mechanism.
Examples: Sertraline, Fluoxetine
- Chemotherapy agents
Effect: Induces early menopause/directly affects bone turnover.
Example: Various drugs used in cancer treatment.
- Diuretics
Effect: Increases calcium loss in urine.
Example: Furosemide
What you can do…
- Have a DXA Bone Density Scan as a baseline or as part of monitoring.
- Ensure adequate calcium and vitamin D intake.
- Increase weight-bearing exercise.
Bottom line: Low bone density shows up on a DXA scan first – if you are waiting for symptoms, you’re often too late.
Next time: Nutrition for strong bones
