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<p>Several medications can negatively affect bone metabolism, causing osteoporosis and leading to an increased risk of fractures. They can have direct effects on osteoblasts and osteoclasts, ultimately resulting in bone mineral loss. The following indirect mechanisms can also trigger bone mineral loss and an increased risk of fractures: disturbances in calcium/vitamin&#xa0;D metabolism with secondary hyperparathyroidism, the development of hypogonadism, or disturbances in phosphate metabolism with subsequent osteomalacia. This review describes a&#xa0;selection of medications that have a&#xa0;negative effect on bone: glucocorticoids, anticoagulants (heparin, vitamin&#xa0;K antagonists), antidepressants, neuroleptics, methotrexate, and intravenous iron therapy. This list is not exhaustive; other medications may also be toxic to bone. The most clinically relevant bone damage is caused by systemic glucocorticoid therapy. Drug-induced bone damage is particularly relevant in older individuals, especially those with potential postmenopausal or age-related osteoporosis, and often involves a&#xa0;combination of several bone-toxic medications. Therefore, bone health should be considered when using potentially bone-damaging drugs for extended periods. An osteological evaluation, including laboratory tests and fracture risk assessment (FRAX), is recommended, and the use of less bone-toxic medications should also be considered. If necessary, guideline-based osteoporosis therapy should be initiated.</p>

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Medikamente mit einem erhöhten Risiko für den Knochen

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年4月14日

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  • Rudolf W. Gasser

摘要

Several medications can negatively affect bone metabolism, causing osteoporosis and leading to an increased risk of fractures. They can have direct effects on osteoblasts and osteoclasts, ultimately resulting in bone mineral loss. The following indirect mechanisms can also trigger bone mineral loss and an increased risk of fractures: disturbances in calcium/vitamin D metabolism with secondary hyperparathyroidism, the development of hypogonadism, or disturbances in phosphate metabolism with subsequent osteomalacia. This review describes a selection of medications that have a negative effect on bone: glucocorticoids, anticoagulants (heparin, vitamin K antagonists), antidepressants, neuroleptics, methotrexate, and intravenous iron therapy. This list is not exhaustive; other medications may also be toxic to bone. The most clinically relevant bone damage is caused by systemic glucocorticoid therapy. Drug-induced bone damage is particularly relevant in older individuals, especially those with potential postmenopausal or age-related osteoporosis, and often involves a combination of several bone-toxic medications. Therefore, bone health should be considered when using potentially bone-damaging drugs for extended periods. An osteological evaluation, including laboratory tests and fracture risk assessment (FRAX), is recommended, and the use of less bone-toxic medications should also be considered. If necessary, guideline-based osteoporosis therapy should be initiated.