Insights from ENDO 2010, The Endocrine Society's Meeting & Expo
CME Information
Premeeting Overview
Skeletal Complications of Medications
Primary osteoporosis is a disease of low bone mass that is most commonly caused by a reduction in estrogen in postmenopausal women. Several secondary causes of osteoporosis have also been identified, including the administration of certain medications. Long-term glucocorticoid administration has long been associated with the development of osteoporosis.1 Emerging research is beginning to associate the use of selective serotonin reuptake inhibitors (SSRIs) and proton pump inhibitors (PPIs) with the development of osteoporosis.2,3
Fractures have been identified as among the most common and serious adverse events associated with the use glucocorticoids.4,5 The risk of fracture has been shown to increase within a period of 2 to 3 months after initiation of long-term glucocorticoid therapy and to decrease soon after glucocorticoid therapy ends.6 Fracture risk has been shown to increase at a rate that is proportional to the daily dose of glucocorticoid therapy.7,8 Bisphosphonates are an effective treatment for glucocorticoid-induced osteoporosis.9
More recently, a link between the administration of SSRIs and the development of osteoporosis has been established. In both men and women, the use of SSRIs, but not tricyclic antidepressants, was shown to result in a decrease in bone mineral density (BMD) values.2,10 The risk of a fragility fracture was found to be twice as high in patients over 50 taking SSRIs than in patients who were not taking SSRIs.11 SSRIs are also associated with the greatest risk of fracture relative to other classes of psychotropic medication.12
The relationship between PPI administration and the development of osteoporotic fractures is controversial. In 2006, Yang et al published a case-control study using the United Kingdom–based General Practice Research Database (N=148,942) and found that patients who received long-term, high-dose PPIs were more than twice as likely to develop a hip fracture than were patients who did not use PPIs.3 Several other publications found that PPIs were associated with a smaller, but still elevated, risk for hip fracture relative to patients not receiving PPIs.13-15 However, a study by Targownik et al found that PPIs were not associated with the development of osteoporosis.16 The Canadian Association of Gastroenterology has stated that the current data are not sufficiently conclusive to indicate a causal link between PPI usage and the development of a hip fracture.17
