10 Medications That May Increase Your Risk of Osteoporosis

As we age, the strength and density of our bones weaken. This may lead to low bone density and ultimately raise your risk for bone fractures. Having slightly weaker-than-normal bones is called osteopenia. And very low bone mass is known as osteoporosis. Not everyone with low bone density will develop osteoporosis, but it’s still a key risk factor for future fractures.

Several medications can lower bone density and weaken your bones. If you take one of these, your healthcare provider may keep a closer eye on your bone density with a DEXA (dual-energy X-ray absorptiometry) scan.

Let’s take a closer look at 10 medications that may weaken your bones and raise your risk for fractures.

1. Corticosteroids

Corticosteroids are prescribed for multiple conditions, including asthma and autoimmune disorders. Some examples include:

• Prednisone

• Methylprednisolone (Medrol)

• Fluticasone (Flovent)

Bone loss is a well-known side effect of taking corticosteroids. That’s because these medications decrease bone formation. Without new bone cells to keep them strong, your bones weaken and become more likely to break.

Bone loss is more likely with high doses of oral steroids. It’s also more likely if you take them for a long period of time or if you’re aged 65 years or over. To avoid this side effect, your healthcare provider may have you take these medications for the shortest amount of time possible. If you’re taking them long-term, your provider will likely monitor your bone density to make sure it stays at a healthy level.

2. SSRIs, such as Prozac

Selective serotonin reuptake inhibitors (SSRIs) are a class of medications that treat depression. Some common SSRIs include fluoxetine (Prozac) and escitalopram (Lexapro). Studies have shown that taking SSRIs might weaken your bones.

Your risk might be higher if you take multiple medications affecting serotonin, a chemical involved with mood. Long-term use can also be a risk factor. If you’re taking an SSRI long-term, your healthcare provider may want to monitor your bone density. And if you’ve been diagnosed with osteoporosis, talk to your provider about the risks and benefits before starting an SSRI.

3. Proton Pump Inhibitors, such as Nexium

Proton pump inhibitors (PPIs) are frequently taken for chronic acid reflux. However, with long-term use, they can lead to bone loss and osteoporosis. Researchers suspect that PPIs may stop your body from absorbing calcium. So instead, your body takes calcium from your bones, which weakens them.

The FDA requires prescription PPIs to include a warning about the risk of bone loss if you take them. Unlike other medications, this risk is linked to both short-term (less than 1 year) and long-term use. 

However, the warning doesn’t apply to over-the-counter (OTC) PPIs. That’s because you shouldn’t take OTC versions for more than 2 weeks. Which probably isn’t enough time to affect your bone density.

It’s best to take a PPI for the shortest amount of time necessary. Talk to your healthcare provider if you’re taking a PPI long-term and are concerned about the risk of bone loss.

4. Certain diabetes medications, such as Actos and Invokana

Some Type 2 diabetes (T2D) medications have also been associated with a higher risk of broken bones. These include pioglitazone (Actos) and canagliflozin (Invokana).

About twice as many females with T2D who took pioglitazone had fractures compared to placebo in clinical studies. This higher risk wasn’t observed in males.

In 2015, the FDA added a warning about a higher risk of low bone mass and fractures from Invokana. Your risk can go up as early as 12 weeks after starting treatment. More research is needed to understand if all medications in the SGLT2 inhibitor class have this risk. So far, results are mixed.

5. Anti-androgen medications

Anti-androgen medications are mainly taken to treat prostate cancer. Examples include bicalutamide (Casodex), or Xtandi (enzalutamide).

These medications lower male hormone levels and help prevent prostate cancer from returning. However, they can result in bone loss and osteoporosis. This is because hormones like testosterone play a large role in bone health.

If you take an anti-androgen medication, your healthcare provider will likely monitor your bone density. They may also prescribe a medication like zoledronic acid (Reclast) or denosumab (Prolia). These medications can help prevent bone loss caused by anti-androgen medications.

6. Certain seizure medications

Carbamazepine (Tegretol), phenytoin (Dilantin), and divalproex (Depakote) are taken to prevent seizures. However, they can also cause bone loss.

Vitamin D is a nutrient we need to keep our bones strong — but it’s not active in our bodies right away. First, it has to be converted to 25-hydroxyvitamin D, and then to calcitriol (the active form of vitamin D). But carbamazepine and phenytoin can intervene in this process, as they turn on a liver enzyme that breaks down 25-hydroxyvitamin D before it can be activated, leading to weaker bones.

Valproate, another seizure medication, lowers bone density too, but in a different way. It’s thought to activate cells that break bone down. This leads to bone loss.

You often need to take seizure medications for a long time. So your healthcare provider will likely check your bone health and adjust your medications as needed if low bone density becomes an issue. Your provider may also recommend taking vitamin D and/or calcium supplements.

7. Loop diuretics

Loop diuretics (water pills), like furosemide (Lasix) and bumetanide (Bumex), can lower the amount of calcium in your bones. Some studies show that these medications lower bone density in males and postmenopausal females. They may also raise the risk of fractures, according to some (but not all) studies.

If you take a water pill, ask your healthcare provider if it may affect your bones. They can suggest ways to keep your bones healthy and prevent fractures.

8. Anti-estrogen medications

Anti-estrogen therapies treat or prevent certain types of breast cancer. They block estrogen, which some breast cancers need to grow. Common examples include:

• Tamoxifen (Soltamox)

• Letrozole (Femara)

• Anastrozole (Arimidex)

• Exemestane (Aromasin)

These medications can be detrimental to bone health. This is because estrogen plays an important role in preventing bone loss. Blocking estrogen causes your body to break down more bone than it should.

If you take one of these medications, your healthcare provider may prescribe a medication to help prevent bone loss, such as Prolia.

9. Tramadol

Tramadol (Conzip, Qdolo) is an opioid pain medication. It has many risks, and bone fractures might be one of them. One study compared people age 50 and older taking tramadol versus other medications. After 1 year, about twice as many people had hip fractures if they took tramadol versus celecoxib (Celebrex).

Your risk might be higher if you take tramadol for a long time. But more research is needed. Researchers think the risk of broken bones might be due to tramadol raising your risk for falls, rather than any effect it might have on your bones directly.

10. Certain transplant medications, such as cyclosporine

If you’ve received an organ or bone marrow transplant, you’re probably taking medications to suppress your immune system. This helps your body accept the new organ or tissue. But certain organ transplant medications can lead to osteoporosis. Some examples include cyclosporine (Sandimmune, Neoral) and tacrolimus (Prograf, Astagraf XL, Envarsus XR).

While not entirely clear, researchers think these medications might affect the cells that break down and build new bone.

Your healthcare provider will likely monitor your bone density if you’re taking these medications. They may recommend vitamin D and calcium supplements, as well.

What works to keep your bones strong if you’re taking these medications?

Proper nutrition, limiting alcohol, and regular exercise are all ways to prevent osteoporosis and keep your bones healthy.

If you’re taking a medication that makes osteoporosis more likely, your healthcare provider may also recommend one of the following treatment options:

• Vitamin D and/or calcium supplements. These vitamins are the building blocks of healthy bones.

• Bisphosphonates, such as alendronate (Fosamax) or Reclast. These medications attach to the bone and block the cells that break it down.

• Monoclonal antibodies, such as Prolia or romosozumab (Evenity). These medications block proteins that break down bone and help the body make new bone.

• Parathyroid hormone analogues, such as teriparatide (Forteo). These medications help stimulate bone growth.

If you have low bone density, the best way to avoid a fracture is to prevent falls. This can be done through strengthening and balance exercises. You can also clear clutter and trip hazards at home.

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Written by:

Kristianne Hannemann, PharmD

Kristianne Hannemann, PharmD, is a licensed pharmacist in California. She has been a retail pharmacy manager and staff pharmacist for over 7 years and has contributed drug information content to different health companies.

Edited by:

Stacia Woodcock, PharmD

Stacia Woodcock, PharmD, is a pharmacy editor for GoodRx. She earned her Doctor of Pharmacy degree from the University of Kentucky and is licensed in New York and Massachusetts.

Reviewed by:

Austin Ulrich, PharmD, BCACP

​​Austin Ulrich, PharmD, BCACP, is a board-certified ambulatory care clinical pharmacist. Ulrich’s experience includes direct patient care in hospital and community pharmacies.

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