Medical Edge Newspaper Column

Drugs, Medical Conditions Can Contribute To Bone Loss

Feb. 26, 2006
DEAR MAYO CLINIC:
My mother has very bad bone degeneration due to osteoporosis, arthritis and scoliosis. She is shrinking and her head is falling to the front. She's being managed for pain, but her condition is getting worse and I fear she is giving up. Is there anything that can be done? -- Tucson, Ariz.

ANSWER:
Your mother's advanced bone loss is challenging to manage, but it's possible that more can be done to improve her condition.

First, make sure that the osteoporosis -- not just the pain -- is being treated. Treatment can slow or stop further bone loss and physical decline.

Her doctor needs to determine the cause of the bone loss. While osteoporosis is related to aging and menopause, secondary causes are a factor in 20 percent to 30 percent of postmenopausal women. Secondary causes can include medications and other medical conditions.

• Medications: Long-term use of corticosteriods to treat asthma, rheumatoid arthritis and other inflammatory conditions can contribute to lower bone mass. Anticonvulsants, thyroid medications, immunosuppressants given after organ transplant, diuretics and blood thinners such as heparin can contribute to bone loss.

• Medical conditions: Endocrine disorders including Type 1 diabetes and thyroid conditions; disorders of the stomach, intestine and liver; and rheumatoid arthritis are among medical conditions that could cause bone loss.

Once the causes are determined, the doctor can develop a treatment plan that includes adequate calcium and vitamin D, medications, bracing and exercise. In addition, cigarette smoking and excess alcohol consumption can promote bone loss and should be avoided.

There are five classes of medication that can be considered for the prevention and treatment of osteoporosis. The International Osteoporosis Foundation Web site (www.osteofound.org) has more information about these medications.

Bracing would support your mother's neck and back, and help prevent additional abnormal curving of her back. You may want to consult with a physical medicine and rehabilitation physician for recommendations.

Your mother should stay active, with stretching and weight-bearing exercise if possible. Consult with a physical therapist to develop a program that your mother can do safely.

Even though your mother's osteoporosis is advanced, steps can be taken to make her comfortable, slow or stop additional bone loss, and avoid further complications.

-- Randy Shelerud, M.D., Spine Center, Mayo Clinic, Rochester, Minn.