Dateline: April 2011 You may be very worried about osteoporosis - given the media blitz for bisphosphonate drugs. But, are you aware of common medical interventions that result in osteoporosis? In this letter, I will discuss the most common prescription drugs that contribute to this problem.

I. Oral Glucocorticoids: There are many prescription drugs that fall under this category. Anything that is classified as a "corticosteroid" or "steroid" is most probably a glucocorticoid, since these terms are used interchangeably. Prednisone is the oldest of these drugs, but there are now many variations on this theme. The most important thing you can do to protect yourself is look the drug up on line, or ask your pharmacist. Among the most common uses for these drugs are in asthma medications, and for auto-immune diseases.

These drugs are associated with a 20% to 200% increased risk of vertebral fractures, for those who use as little as 2.5 mg/day for 6 months or more. For each 10 mg increase in dose, there is a 62% increase in risk for bone fracture. (Van Staa, TP, et al., J Bone Miner Res, June 2000; 15(6): 993-1000. Van Staa, TP, et al., Arthritis Rheum, Nov 2003; 48(11): 3224-3229) Typical doses far exceed the 2.5 mg/day minimum. The good news is that the fracture risk normalizes after stopping the medication.

Although the study was done on oral drugs, it is also known that the injections given for arthritic conditions ("cortisone shots") also reduce bone density and weaken ligaments associated with the joint.

2. Anti-Ulcer Drugs: These are among the most common prescription and over-the-counter medications in America. I'm sure you've heard of them: Prilosec©, Prevacid©, Nexium©, Zantac©, etc. Remember the commercial about "the little purple pill"? Well, these drugs have a severe impact on the risk of hip fractures.

There are two categories of these drugs: PPIs (proton pump inhibitors) and H2 blockers (or H2 receptor antagonists). Both categories impact the risk of fracture. In one large study on PPIs (135,3896 controls, with 13,556 people with hip fractures), the risk of hip fracture increased steadily the longer the drug(s) was used. The risk increased by 22% with 1 year of treatment; but by the 3rd year it was up to 54%. After 4 years, it was up to 59%. Men are more at risk than women, and it was dose dependent. (Yang, YX, et al., JAMA, 2006; 296(24): 2947-2953)

3. Antibiotics: This finding may have surprised the medical profession, but for those of us in natural health care who have been trying for more than 75 years to educate the public about the importance of probiotics, it was only to be expected. Remember, antibiotics denude the gut of healthful bacteria - the symbiotes that produce almost all of our vitamin K. A broad spectrum antibiotic can diminishing vitamin K production by as much as 75%! (Conly, J, Stein K, Clin Invest Med, 1994; 17(6): 531-539)

And, please do not be misled. Sugar-laden, commercial yogurt products are inadequate to repopulate the gut. After many years of doing bowel studies, I am well aware of how difficult it is to reinoculate the bowel.

4. Synthetic Thyroid: There is a long-standing controversy surrounding the use of Synthroid© (or levothyroxine) and osteoporosis. It is well known that too much of the drug can contribute to osteoporosis. And, warnings are included that people at risk for osteoporosis should not take this drug, unless they are very carefully monitored. However, I have many patients with osteoporosis who have never been told that their prescription may be contributing to their problem. One of the physiologic issues is that, as with all endocrine processes, the body maintains a careful balance between the hormone that removes calcium from the bones and the one that remineralizes the bones. Levothyroxine takes calcium out of the bones; calcitonin (the "other" thyroid hormone) puts it back. When levothyroxine is prescribed, the balance is tipped towards removing calcium from the bones. Since the drug companies constantly oppose this very common sense realization, I doubt that there will ever be definitive "scientific studies" to validate the down side of Synthroid©.

If you have been receiving our newsletters and update for a while, you know that we have natural strategies for improving your bone status. If you are concerned about your bone health, or if you have been diagnosed with either osteopenia or osteoporosis, give us a call, and make an appointment for a consultation.