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    Home > Active Ingredient News > Endocrine System > Is osteoporosis only due to calcium deficiency?

    Is osteoporosis only due to calcium deficiency?

    • Last Update: 2021-03-22
    • Source: Internet
    • Author: User
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    *Only for medical professionals to read for reference.
    Be wary of the silent "killer" behind osteoporosis.
    .
    .
    Many people think that osteoporosis is caused by calcium deficiency, and drug-induced osteoporosis is often overlooked.

    In fact, adverse drug reactions lead to drug-induced osteoporosis from time to time, accounting for 8.
    6% to 17.
    3% of all osteoporosis patients [1].

    Therefore, elderly osteoporosis needs to be alert to adverse drug reactions, it may be a "silent killer.
    "
    Drugs prone to osteoporosis 1 Anticoagulant drugs ❶ Warfarin [2] By antagonizing vitamin K, inhibiting the carboxylation of osteocalcin, reducing bone calcium deposition, inhibiting bone mineralization, and promoting bone resorption, resulting in osteoporosis, common It is found on the distal radius, spine and hip bones, and also on the ribs.

    Treatment: Patients who take warfarin for a long time (atrial fibrillation, pulmonary embolism, heart valve replacement, etc.
    ) should be supplemented with calcium and vitamin D to prevent osteoporosis.
    For patients who have developed osteoporosis, they should be based on their specific conditions.
    Choose to treat with bisphosphonates, calcitonin, estrogen and parathyroid analogs.

    ❷ Osteoporosis induced by heparin [1] occurs in the spine and ribs, which may be related to increasing the dissolution of bone collagen, promoting bone resorption and inhibiting bone formation.

    Long-term large-scale application can cause osteoporosis.

    2 Glucocorticoids The incidence of osteoporosis in patients who have been treated with glucocorticoids (such as dexamethasone, prednisone, beclomethasone, etc.
    ) for a long time (more than 1 year) is as high as 30%-50%[3], and it is the most Drugs that can easily cause drug-induced osteoporosis.

    The effect on bones is time- and dose-dependent, and is mainly characterized by low bone turnover and fractures.
    Through the effects on bone cells, osteoblasts, and osteoclasts, the risk of fractures can be increased before the bone density decreases.

    Treatment: Most advocate the use of bisphosphonates as first-line drugs, while supplementing calcium and vitamin D, and use calcium and vitamin D as the basic drugs for primary and secondary prevention.

    3 Proton pump inhibitors issued a warning in 2010 by the FDA: Patients taking PPIs for more than 1 year or taking higher doses may increase the risk of hip, wrist and spine fractures.

    my country's Food and Drug Administration issued a warning in 2013: Long-term use of higher doses of PPIs can increase the risk of fractures.

    Stomach medicines (omeprazole, pantoprazole, etc.
    ) that are commonly available for living at home should not be taken for a long time at will.

    Treatment: For the decrease in calcium absorption caused by gastric acid suppression, calcium supplements can be appropriate.

    Calcium should be the first choice for calcium carbonate.
    Its calcium absorption rate is similar to that of milk.
    At the same time, vitamin D supplementation can increase calcium absorption.

    4 Antidiabetic drugs thiazolidinediones (rosiglitazone and pioglitazone) can improve the risk of osteoporosis and fractures while improving insulin resistance and lowering blood sugar [4].

    The osteoporosis caused by it is manifested as body bone involvement, which is more common in women.
    The fracture site is common in the upper limbs, involving the humerus and hands; especially in postmenopausal women, this type of hypoglycemic drugs should be carefully selected; Patients should strengthen the follow-up of bone mineral density and bone metabolism indicators.

    5 The anti-epileptic drug phenytoin is the first drug that causes osteoporosis in anti-epileptic drugs, followed by carbamazepine, and the least impact is sodium valproate [5].

    Therefore, when taking phenytoin sodium for a long period of time, prepare appropriate amount of vitamin D, do more outdoor activities, supplement appropriate amount of calcium and phosphorus, and check bone density regularly.

    In addition, quinolones, thalidomide, thyroid hormones, gonarelin, leuprolide, methotrexate, etc.
    can also cause drug-induced osteoporosis.

    Elderly patients with chronic diseases who use the above-mentioned drugs should always be alert to the occurrence of drug-induced osteoporosis.

    During medication, it is necessary to regularly check bone density or X-ray or CT scan or NMR scan to closely monitor bone metabolism, take more outdoor activities, appropriately supplement calcium, vitamin D and vitamin K, and select drugs in a targeted manner under the guidance of doctors.
    Delay osteoporosis. References: [1] Zeng Liping, Xu Yinghong.
    Senile osteoporosis needs to be alert to adverse drug reactions[J].
    Modern Diagnosis and Treatment,2014,(21):5008-5009,5010.
    [2] Zhao Fei, Zhang Yina.
    The pathogenesis and treatment strategies of warfarin-induced osteoporosis[J].
    Chinese Journal of Multiple Organ Diseases in the Elderly,2016,15(10):796-800.
    DOI:10.
    11915/j.
    issn.
    1671-5403.
    2016.
    10.
    191.
    [3] Zhang Lili, Fu Xiaomin, Liu Minyan et al.
    Review of drug-induced osteoporosis[J].
    Chinese Drug Application and Monitoring, 2015, (6): 383-386.
    [4] Sheng Hui, Li Wenjun, Sheng Chunjun, etc.
    Thiazolidinedione hypoglycemic drugs and osteoporosis[J].
    Chinese Journal of Osteoporosis and Bone Mineral Diseases,2011,04(2):113-115.
    DOI:10.
    3969/j.
    issn.
    1674-2591.
    2011 .
    02.
    008.
    [5],.
    Studies have found that phenytoin is the first antiepileptic drug to cause osteoporosis[J].
    Medical Information,1997,0(11)
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