Medicines Effects on Bones

A medical treatment that is highly destructive to the skeleton is seizure treatment.  Seizures are an electrical phenomenon of the brain and virtually every medication, including Dilantin and Tegretol, used to treat seizures destroy the skeleton over time.  If I had my way I would aggressively treat the skeleton of every patient receiving anti-seizure medications, but sadly this is not on the radar screen of neurologists. They are focused on stopping further seizures. There is also evidence that long-term use of steroids and of many stomach medications that contain omeprazole such as Prilosec and Zegreid and other H2 blockers such as Pepcid, Tagamet and Zantac can have minor effects on bone density.

Opinion pendulums swing fairly dramatically in the world of medicine, for hormone replacement therapy (HRT) and then against it, for sun exposure and then against it and then for it again. Both HRT and sun are good for bones. It is a mistake to think that science only moves forward.  There are significant regressions and many times major treatments and thinking take decades to be identified and corrected.  One must always question the motivation of those putting forward absolutes that may involve an unseen profit or simply be “‘silo” thinking.

The truth is that there is a lot of soft bone out there that is going to become a significant health risk as we all age. There is no quick fix to undo 60 or 70 years of bone resorption.  Certainly, there is no panacea in calcium and vitamin D therapy.  Fosamax, Boniva and Evista are all Bis Phosphanates and do temporarily seemed to halt bone resorption but can be associated with a whole new category of long bone fractures.  Hormone therapies such as calcitonin are helpful.  Intravenous treatment with medications like Reclast have great promise.  None of these therapies are successful without adequate calcium and vitamin D. Without a doubt increasing weight bearing activity is the best treatment available.  Bone grows along the axis of weight bearing, which is defined by Wolff’s Law. Julius Wolff was a German surgeon in the 19th century who found that bone in a healthy person will become stronger and denser in response to stress. This is so clear that we can actually apply an electrical signal to long bones and cause them to grow.  This was discovered by measuring the electrical signal around bones that had weight applied to them and noticing an inductance signal.  By reversing the process, we can actually induce bone growth.  Since bone is a naturally replenishing living organ in the body, we are able to modify the mix of bone turnover, production and resorption.