The Effects of Medications on Bone : JAAOS - Journal of the American Academy of Orthopaedic Surgeons (original) (raw)

Articles

Goodman, Stuart B. MD, PhD; Jiranek, William MD; Petrow, Edward DO; Yasko, Alan W. MD

Dr. Goodman is Professor, Department of Orthopaedic Surgery, Stanford University School of Medicine, Palo Alto, CA. Dr. Jiranek is Associate Professor, Department of Orthopaedic Surgery, Virginia Commonwealth University Health System, Richmond, VA. Dr. Petrow is Adult Reconstruction Fellow, Department of Orthopaedic Surgery, Virginia Commonwealth University Health System, Richmond. Dr. Yasko is Professor and Vice-Chairman of Fiscal Affairs and Research, Northwestern University Feinberg School of Medicine and the Robert H. Lurie Comprehensive Cancer Center, Chicago, IL

None of the following authors or the departments with which they are affiiated has received anything of value from or owns stock in a commercial company or institution related directly or indirectly to the subject of this article: Dr. Goodman, Dr. Jiranek, Dr. Petrow, and Dr. Yasko.

Reprint requests: Dr. Goodman, Department of Orthopaedic Surgery, Stanford University, 300 Pasteur Drive, R153, Stanford, CA 94305-5326.

Abstract

Medications taken for the treatment of arthritis and psychotropic and epileptic disorders, as well as anticoagulants, antacids, bisphosphonates, corticosteroids, and antineoplastic drugs, can profoundly affect bone metabolism. In some scenarios (eg, osteoporosis), these effects are intended; in others (eg, rickets, osteomalacia secondary to antiepileptic drugs), potentially adverse side effects of medications on bone may occur. Nonsteroidal antiinflammatory drugs appear to delay fracture healing and bone ingrowth, although these effects are reversible. Disease-modifying antirheumatic drugs do not appear to affect bone metabolism adversely when taken in the low dosages currently prescribed. Bisphosphonates are useful in restoring bone mass in cases of postmenopausal osteoporosis, glucocorticoid-induced osteoporosis, Paget's disease, and neoplastic conditions with bone loss and hypercalcemia. Corticosteroids and cancer chemotherapeutic agents generally affect bone adversely and increase fracture risk.