Last week we had an Osteoporosis CME. One of the cases for discussion was steroid induced osteoporosis. For good or bad, steroids are famous. Most educated folks are wary of them. So when you say, steroids do something bad to bad, they readily understand. After all, for all their life saving potential, this class of drugs is known to be associated with a variety of side effects.
The problem is steroids aren’t the only drugs which cause osteoporosis. Some of the others are far more common, and though not as impactful, fly under our radar because of their sheer banality. Even the FRAX risk calculator which I shared last week, has no provision to account for these “other drugs”. One such drug-class is the anti — acid medications called proton pump inhibitors.( Omeprazole, pantoprazole, rabeprazole etc — anything that ends with ‘prazole’)
These drugs don’t cause external physical changes, unlike steroids, but that doesn’t mean they are innocuous. Unfortunately many patients take these drugs for years together, only to find that what started off as an ulcer, has become a drug addiction.
They damage the bone by preventing the absorption of important minerals and vitamins — Vitamin B12, calcium, iron and magnesium. While individual studies differ, the overall pattern is clear — an increased risk of osteoporosis in those who are long term users of these drugs.
If you or anyone you know is a long term PPI (proton pump inhibitor) user do the following
- discuss with your gastroenterologist about whether it is needed at all
- discuss with an endocrinologist about bone health assessment
