Pharmacogenic osteoporosis beyond cortisone. Proton pump inhibitors, glitazones and diuretics

• Published in: Zeitschrift für Rheumatologie 2014-05, Vol.73 (4), p.323
• Main Authors: Kann, P H, Hadji, P, Bergmann, R S
• Format: Article
• Language: ger
• Subjects: Cortisone - adverse effects; Cortisone - therapeutic use; Diuretics - adverse effects; Diuretics - therapeutic use; Drug Substitution; Humans; Long-Term Care; Osteoporosis - chemically induced; Osteoporosis - diagnosis; Proton Pump Inhibitors - adverse effects; Proton Pump Inhibitors - therapeutic use; Risk Factors; Statistics as Topic; Thiazolidinediones - adverse effects; Thiazolidinediones - therapeutic use
• ISSN: 1435-1250
• DOI: 10.1007/s00393-013-1286-7

[corrected] There are many drugs which can cause osteoporosis or at least favor its initiation. The effect of hormones and drugs with antihormonal activity, such as glucocorticoids and aromatase inhibitors, on initiation of osteoporosis is well known. In addition, proton pump inhibitors, glitazones and diuretics also influence the formation of osteoporosis. The results of currently available studies on the correlation between proton pump inhibitors, glitazones and diuretics on formation of osteoporosis were evaluated and summarized. Proton pump inhibitors and glitazones increase the risk for osteoporotic fractures. Loop diuretics may slightly increase fracture risk, whereas thiazides were shown to be osteoprotective by reducing fracture probability on a relevant scale. Proton pump inhibitors should not be prescribed without serious consideration and then only as long as necessary. Alternatively, the administration of the less effective H2 antagonists should be considered when possible due to the reduction of acid secretion. Because the long-term intake of thiazides is associated with a clinically relevant reduction in the risk of fractures and they are economic and well-tolerated, prescription can be thoroughly recommended within the framework of differential diagnostic considerations in an appropriate clinical context. The briefly increased risk of falling immediately after starting diuretic therapy is the only point which needs to be considered.