{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T18:21:54Z","timestamp":1790878914881,"version":"4.1.0"},"reference-count":129,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2026,1,26]],"date-time":"2026-01-26T00:00:00Z","timestamp":1769385600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>The administration of various medications can induce bone loss as an adverse effect and may result in drug-induced osteoporosis, an important and clinically relevant form of secondary osteoporosis associated with an increased fracture risk. This review summarizes the skeletal effects of selected commonly used drugs with respect to bone metabolism, bone mineral density, and fracture outcomes. Medications may exert direct effects on osteoblasts and\/or osteoclasts, leading to impaired bone remodeling and reduced bone mass. Alternatively, indirect mechanisms may contribute to skeletal damage, including disturbances in calcium and vitamin D metabolism with subsequent secondary hyperparathyroidism, as well as therapy-induced hypogonadism. Drug classes frequently associated with drug-induced osteoporosis during long-term use include glucocorticoids, aromatase inhibitors, androgen-deprivation therapy, thyroxine, proton pump inhibitors, anticoagulants (heparin and vitamin K antagonists), antidepressants, neuroleptics, and thiazolidinediones. Importantly, this overview represents a selection of relevant agents and does not aim to provide an exhaustive list. When prescribing potentially bone-damaging medications over extended periods, particularly in older individuals, bone health should be proactively considered. Evaluation should include laboratory assessment, fracture risk estimation (e.g., FRAX\u00ae), and bone mineral density measurement when appropriate. Adequate calcium and vitamin D intake should be ensured, and guideline-based osteoporosis therapy initiated when indicated.<\/jats:p>","DOI":"10.3390\/jcm15030993","type":"journal-article","created":{"date-parts":[[2026,1,27]],"date-time":"2026-01-27T09:21:40Z","timestamp":1769505700000},"page":"993","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Drug-Induced Osteoporosis"],"prefix":"10.3390","volume":"15","author":[{"given":"Rudolf Wolfgang","family":"Gasser","sequence":"first","affiliation":[{"name":"Department of Internal Medicine I, Medical University of Innsbruck, 6020 Innsbruck, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roland","family":"Kocijan","sequence":"additional","affiliation":[{"name":"1st Medical Department, Ludwig Boltzmann Institute of Osteology at the Hanusch Hospital of OEGK and AUVA Trauma Centre Meidling, Hanusch Hospital, 1140 Vienna, Austria"},{"name":"Metabolic Bone Diseases Unit, Medical Faculty, Sigmund Freud University Vienna, Sigmund Freud Platz 3, 1020 Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Afrodite","family":"Zendeli","sequence":"additional","affiliation":[{"name":"Metabolic Bone Diseases Unit, Medical Faculty, Sigmund Freud University Vienna, Sigmund Freud Platz 3, 1020 Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0236-9998","authenticated-orcid":false,"given":"Heinrich","family":"Resch","sequence":"additional","affiliation":[{"name":"Metabolic Bone Diseases Unit, Head Osteology, Medical Faculty, Sigmund Freud University Vienna, Sigmund Freud Platz 3, 1020 Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,1,26]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"877","DOI":"10.1016\/j.amjmed.2010.02.028","article-title":"Drug-induced osteoporosis: Mechanism and clinical implications","volume":"123","author":"Mazziotti","year":"2010","journal-title":"Am. J. Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1177\/1759720X14546350","article-title":"Medication-induced osteoporosis: Screening and treatment strategies","volume":"6","author":"Panday","year":"2014","journal-title":"Ther. Adv. Musculoskel. Dis."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1005","DOI":"10.1080\/14740338.2018.1524868","article-title":"Drug-induced bone loss: A major safety concern in Europe","volume":"17","author":"Nguyen","year":"2018","journal-title":"Expert Opin. Drug Saf."},{"key":"ref_4","unstructured":"Javed, L., Khakwani, A., Khan, U., and Humphrey, M.B. (2024). Medication-induced fractures: Screening and treatment strategies. Am. J. Med. Sci., ahead of print."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"294","DOI":"10.1002\/acr.21796","article-title":"Prevalence of oral glucocorticoid usage in the United States: A general population perspective","volume":"65","author":"Overman","year":"2013","journal-title":"Arthritis Care Res."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1056\/NEJMcp1012926","article-title":"Clinical practice. Glucocorticoid-induced bone disease","volume":"365","author":"Weinstein","year":"2011","journal-title":"N. Engl. J. Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"98","DOI":"10.1038\/nrrheum.2014.188","article-title":"Glucocorticoid-induced osteoporosis: Who to treat with what agent?","volume":"11","author":"Rizzoli","year":"2015","journal-title":"Nat. Rev. Rheumatol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"G1","DOI":"10.1093\/ejendo\/lvae146","article-title":"Prevention and treatment of glucocorticoid-induced osteoporosis in adults: Recommendations from the European Calcified Tissue Society","volume":"191","author":"Paccou","year":"2024","journal-title":"Eur. J. Endocrinol."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Laurent, M.R., Goemaere, S., Verroken, C., Bergmann, P., Body, J.J., Bruy\u00e8re, O., Cavalier, E., Rozenberg, S., Lapauw, B., and Gielen, E. (2022). Prevention and Treatment of Glucocorticoid-Induced Osteoporosis in Adults: Consensus Recommendations from the Belgian Bone Club. Front. Endocrinol., 13.","DOI":"10.3389\/fendo.2022.908727"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1035","DOI":"10.1007\/s00586-005-0056-x","article-title":"Glucocorticosteroid-induced spinal osteoporosis: Scientific update on pathophysiology and treatment","volume":"15","author":"Popp","year":"2006","journal-title":"Eur. Spine J."},{"key":"ref_11","first-page":"S41","article-title":"Clinical and diagnostic features of glucocorticoid-induced osteoporosis","volume":"18","author":"Buckley","year":"2000","journal-title":"Clin. Exp. Rheumatol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1007\/s11657-025-01588-3","article-title":"National Osteoporosis Guideline Group (NOGG). The 2024 UK clinical guideline for the prevention and treatment of osteoporosis","volume":"20","author":"Gregson","year":"2025","journal-title":"Arch. Osteoporos."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"S599","DOI":"10.1007\/s00508-024-02441-2","article-title":"Osteoporose\u2013Definition, Risikoerfassung, Diagnose, Pr\u00e4vention und Therapie (Update 2024): Leitlinie der \u00d6sterreichischen Gesellschaft f\u00fcr Knochen- und Mineralstoffwechsel [Osteoporosis-Definition, risk assessment, diagnosis, prevention and treatment (update 2024): Guidelines of the Austrian Society for Bone and Mineral Research]","volume":"136","author":"Dimai","year":"2024","journal-title":"Wien. Klin. Wochenschr."},{"key":"ref_14","unstructured":"Dachverband Osteologie e.V. (DVO) (2023). Leitlinie 2023\u2013Prophylaxe, Diagnostik und Therapie der Osteoporose bei Postmenopausalen Frauen und bei M\u00e4nnern ab dem 50. Lebensjahr, DVO. Available online: https:\/\/leitlinien.dv-osteologie.org."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.jbo.2017.03.001","article-title":"Management of Aromatase Inhibitor-Associated Bone Loss (AIBL) in postmenopausal women with hormone sensitive breast cancer: Joint position statement of the IOF, CABS, ECTS, IEG, ESCEO IMS, and SIOG","volume":"7","author":"Hadji","year":"2017","journal-title":"J. Bone Oncol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1007\/s11864-021-00835-2","article-title":"Cancer Treatment-Induced Bone Loss (CTIBL): State of the Art and Proper Management in Breast Cancer Patients on Endocrine Therapy","volume":"22","author":"Diana","year":"2021","journal-title":"Curr. Treat. Options Oncol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1016\/j.jsbmb.2005.04.009","article-title":"Long-term effects of aromatase inhibitors on bone","volume":"95","author":"Eastell","year":"2005","journal-title":"J. Steroid. Biochem. Mol. Biol."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Early Breast Cancer Trialists\u2019 Collaborative Group (EBCTCG) (2015). Aromatase inhibitors versus tamoxifen in early breast cancer: Patient-level meta-analysis of the randomised trials. Lancet, 386, 1341\u20131352.","DOI":"10.1016\/S0140-6736(15)61074-1"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1650","DOI":"10.1016\/j.annonc.2020.07.019","article-title":"Bone health in cancer: ESMO Clinical Practice Guidelines","volume":"31","author":"Coleman","year":"2020","journal-title":"Ann. Oncol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1044","DOI":"10.1016\/j.ejca.2005.10.028","article-title":"Effects of third-generation aromatase inhibitors on bone","volume":"42","author":"McCloskey","year":"2006","journal-title":"Eur. J. Cancer"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"100694","DOI":"10.1016\/j.jbo.2025.100694","article-title":"Management of aromatase inhibitor-associated bone loss (AIBL) in women with hormone-sensitive breast cancer: An updated joint position statement of the IOF, CABS, ECTS, IEG, ESCEO, IMS, and SIOG","volume":"53","author":"Hadji","year":"2025","journal-title":"J. Bone Oncol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1016\/S0140-6736(04)17666-6","article-title":"ATAC Trialists\u2019 Group. Results of the ATAC (Arimidex, Tamoxifen, Alone or in Combination) trial after completion of 5 years\u2019 adjuvant treatment for breast cancer","volume":"365","author":"Howell","year":"2005","journal-title":"Lancet"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1793","DOI":"10.1056\/NEJMoa032312","article-title":"A randomized trial of letrozole in postmenopausal women after five years of tamoxifen therapy for early-stage breast cancer","volume":"349","author":"Goss","year":"2003","journal-title":"N. Engl. J. Med."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"486","DOI":"10.1200\/JCO.2006.08.8617","article-title":"Five years of letrozole compared with tamoxifen as initial adjuvant therapy for postmenopausal women with endocrine-responsive early breast cancer: Update of study BIG 1-98","volume":"25","author":"Coates","year":"2007","journal-title":"J. Clin. Oncol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1016\/S1470-2045(07)70003-7","article-title":"Intergroup Exemestane Study group. Skeletal effects of exemestane on bone-mineral density, bone biomarkers, and fracture incidence in postmenopausal women with early breast cancer participating in the Intergroup Exemestane Study (IES): A randomised controlled study","volume":"8","author":"Coleman","year":"2007","journal-title":"Lancet Oncol."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Chang, C.H., Chen, S.J., and Liu, C.Y. (2015). Fracture risk and adjuvant therapies in young breast cancer patients: A population-based study. PLoS ONE, 10.","DOI":"10.1371\/journal.pone.0130725"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"e403","DOI":"10.3346\/jkms.2020.35.e403","article-title":"Osteoporotic Fractures of the Spine, Hip, and Other Locations after Adjuvant Endocrine Therapy with Aromatase Inhibitors in Breast Cancer Patients: A Meta-analysis","volume":"35","author":"Lee","year":"2020","journal-title":"J. Korean Med. Sci."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1093\/jnci\/djx141","article-title":"Toxicity of Extended Adjuvant Therapy with Aromatase Inhibitors in Early Breast Cancer: A Systematic Review and Meta-analysis","volume":"110","author":"Goldvaser","year":"2018","journal-title":"J. Natl. Cancer Inst."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"275","DOI":"10.1007\/s10549-019-05464-w","article-title":"Efficacy and toxicity of extended aromatase inhibitors after adjuvant aromatase inhibitors-containing therapy for hormone-receptor-positive breast cancer: A literature-based meta-analysis of randomized trials","volume":"179","author":"Qian","year":"2020","journal-title":"Breast Cancer Res. Treat."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"100355","DOI":"10.1016\/j.jbo.2021.100355","article-title":"Updated guidance on the management of cancer treatment-induced bone loss (CTIBL) in pre- and postmenopausal women with early-stage breast cancer","volume":"28","author":"Waqas","year":"2021","journal-title":"J. Bone Oncol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1428","DOI":"10.1002\/jbmr.3726","article-title":"Performance of FRAX in Women with Breast Cancer Initiating Aromatase Inhibitor Therapy: A Registry-Based Cohort Study","volume":"34","author":"Leslie","year":"2019","journal-title":"J. Bone Miner. Res."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"4636028","DOI":"10.1155\/2018\/4636028","article-title":"FRAX Calculated without BMD Resulting in a Higher Fracture Risk Than That Calculated with BMD in Women with Early Breast Cancer","volume":"2018","author":"Prawiradilaga","year":"2018","journal-title":"J. Osteoporos."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"20221016","DOI":"10.1259\/bjr.20221016","article-title":"High-resolution peripheral quantitative computed tomography: Research or clinical practice?","volume":"96","author":"Gazzotti","year":"2023","journal-title":"Br. J. Radiol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"115787","DOI":"10.1016\/j.bone.2020.115787","article-title":"Circulating miRNAs in bone health and disease","volume":"145","author":"Grillari","year":"2021","journal-title":"Bone"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1131","DOI":"10.1002\/jbmr.4276","article-title":"Longitudinal Changes of Circulating miRNAs During Bisphosphonate and Teriparatide Treatment in an Animal Model of Postmenopausal Osteoporosis","volume":"36","author":"Weigl","year":"2021","journal-title":"J. Bone Miner. Res."},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Early Breast Cancer Trialists\u2019 Collaborative Group (EBCTCG) (2015). Adjuvant bisphosphonate treatment in early breast cancer: Meta-analyses of individual patient data from randomised trials. Lancet, 386, 1353\u20131361. Erratum in Lancet\u00a02016, 387, 30. Erratum in Lancet\u00a02017, 389, 2472. https:\/\/doi.org\/10.1016\/S0140-6736(17)31454-X.","DOI":"10.1016\/S0140-6736(15)60908-4"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"100507","DOI":"10.1016\/j.currproblcancer.2019.100507","article-title":"Efficacy of zoledronic acid for prevention of bone loss in early-stage breast cancer patients receiving adjuvant therapy: A meta-analysis of 13 randomized controlled trials","volume":"44","author":"Mei","year":"2020","journal-title":"Curr. Probl. Cancer"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1007\/s10549-020-05640-3","article-title":"Bone modifying agents for bone loss in patients with aromatase inhibitor as adjuvant treatment for breast cancer; insights from a network meta-analysis","volume":"181","author":"Miyashita","year":"2020","journal-title":"Breast Cancer Res. Treat."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"154962","DOI":"10.1016\/j.metabol.2021.154962","article-title":"Effect of antiresorptive therapy on aromatase inhibitor induced bone loss in postmenopausal women with early-stage breast cancer: A systematic review and meta-analysis of randomized controlled trials","volume":"128","author":"Bassatne","year":"2022","journal-title":"Metabolism"},{"key":"ref_40","first-page":"CD013451","article-title":"Bone-modifying agents for reducing bone loss in women with early and locally advanced breast cancer: A network meta-analysis","volume":"7","author":"Adams","year":"2024","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"6410","DOI":"10.1210\/jc.2005-0183","article-title":"Bone loss after initiation of androgen deprivation therapy in patients with prostate cancer","volume":"90","author":"Greenspan","year":"2005","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"136","DOI":"10.1016\/S0022-5347(05)00033-9","article-title":"Risk of clinical fractures after gonadotropin-releasing hormone agonist therapy for prostate cancer","volume":"175","author":"Smith","year":"2006","journal-title":"J. Urol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"419","DOI":"10.1152\/physrev.2001.81.1.419","article-title":"Sex steroids and bone","volume":"81","author":"Compston","year":"2001","journal-title":"Physiol. Rev."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"211","DOI":"10.6004\/jnccn.2010.0014","article-title":"Adverse effects of androgen deprivation therapy: Defining the problem and promoting health among men with prostate cancer","volume":"8","author":"Saylor","year":"2010","journal-title":"J. Natl. Compr. Cancer Netw."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"154","DOI":"10.1056\/NEJMoa041943","article-title":"Risk of fracture after androgen deprivation for prostate cancer","volume":"352","author":"Shahinian","year":"2005","journal-title":"N. Engl. J. Med."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"1808","DOI":"10.1002\/jbmr.405","article-title":"Fracture risk in men with prostate cancer: A population-based study","volume":"26","author":"Melton","year":"2011","journal-title":"J. Bone Miner. Res."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"2918","DOI":"10.1200\/JCO.2005.01.529","article-title":"Natural history of rising serum prostate-specific antigen in men with castrate nonmetastatic prostate cancer","volume":"23","author":"Smith","year":"2005","journal-title":"J. Clin. Oncol."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"2008","DOI":"10.1097\/01.ju.0000063820.94994.95","article-title":"Randomized controlled trial of zoledronic acid to prevent bone loss in men receiving androgen deprivation therapy for nonmetastatic prostate cancer","volume":"169","author":"Smith","year":"2003","journal-title":"J. Urol."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"1038","DOI":"10.1200\/JCO.2006.07.3361","article-title":"Randomized controlled trial of annual zoledronic acid to prevent gonadotropin-releasing hormone agonist-induced bone loss in men with prostate cancer","volume":"25","author":"Michaelson","year":"2007","journal-title":"J. Clin. Oncol."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"416","DOI":"10.7326\/0003-4819-146-6-200703200-00006","article-title":"Effect of once-weekly oral alendronate on bone loss in men receiving androgen deprivation therapy for prostate cancer: A randomized trial","volume":"146","author":"Greenspan","year":"2007","journal-title":"Ann. Intern. Med."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"745","DOI":"10.1056\/NEJMoa0809003","article-title":"Denosumab in men receiving androgen-deprivation therapy for prostate cancer","volume":"361","author":"Smith","year":"2009","journal-title":"N. Engl. J. Med."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"1316","DOI":"10.1016\/j.juro.2010.06.022","article-title":"Toremifene to reduce fracture risk in men receiving androgen deprivation therapy for prostate cancer","volume":"184","author":"Smith","year":"2010","journal-title":"J. Urol."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"671","DOI":"10.1089\/thy.2024.0232","article-title":"TSH Suppression in Differentiated Thyroid Cancer Patients. Still More Questions than Answers after 30 Years","volume":"34","author":"Biondi","year":"2024","journal-title":"Thyroid"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1159\/000438750","article-title":"The 2015 European Thyroid Association Guidelines on Diagnosis and Treatment of Endogenous Subclinical Hyperthyroidism","volume":"4","author":"Biondi","year":"2015","journal-title":"Eur. Thyroid. J."},{"key":"ref_55","doi-asserted-by":"crossref","unstructured":"Delitala, A.P., Scuteri, A., and Doria, C. (2020). Thyroid Hormone Diseases and Osteoporosis. J. Clin. Med., 9.","DOI":"10.3390\/jcm9041034"},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"3737","DOI":"10.1172\/JCI63948","article-title":"Hyperthyroid-associated osteoporosis is exacerbated by the loss of TSH signaling","volume":"122","author":"Baliram","year":"2012","journal-title":"J. Clin. Investig."},{"key":"ref_57","first-page":"3655","article-title":"Effect of TSH Suppression Therapy on Bone Mineral Density in Differentiated Thyroid Cancer: A Systematic Review and Meta-analysis","volume":"106","author":"Ku","year":"2021","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"e2240823","DOI":"10.1001\/jamanetworkopen.2022.40823","article-title":"Association Between Subclinical Thyroid Dysfunction and Fracture Risk","volume":"5","author":"Daya","year":"2022","journal-title":"JAMA Netw. Open"},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"2055","DOI":"10.1001\/jama.2015.5161","article-title":"for the Thyroid Studies Collaboration. Subclinical thyroid dysfunction and fracture risk: A meta-analysis","volume":"313","author":"Blum","year":"2015","journal-title":"JAMA"},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"685","DOI":"10.1007\/s12020-019-02110-9","article-title":"Association of subclinical thyroid dysfunction with bone mineral density and fracture: A meta-analysis of prospective cohort studies","volume":"67","author":"Zhu","year":"2020","journal-title":"Endocrine"},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1503\/cmaj.071330","article-title":"Use of proton pump inhibitors and risk of osteoporosis-related fractures","volume":"179","author":"Targownik","year":"2008","journal-title":"CMAJ"},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1001\/jama.2010.862","article-title":"Proton pump inhibitors linked to fracture risk","volume":"304","author":"Voelker","year":"2010","journal-title":"JAMA"},{"key":"ref_63","doi-asserted-by":"crossref","unstructured":"Thong, B.K.S., Ima-Nirwana, S., and Chin, K.Y. (2019). Proton Pump Inhibitors and Fracture Risk: A Review of Current Evidence and Mechanisms Involved. Int. J. Environ. Res. Public Health, 16.","DOI":"10.3390\/ijerph16091571"},{"key":"ref_64","doi-asserted-by":"crossref","unstructured":"Lespessailles, E., and Toumi, H. (2022). Proton Pump Inhibitors and Bone Health: An Update Narrative Review. Int. J. Mol. Sci., 23.","DOI":"10.3390\/ijms231810733"},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"236","DOI":"10.1016\/j.jocd.2018.06.008","article-title":"Lower Trabecular Bone Score is Associated with the Use of Proton Pump Inhibitors","volume":"22","author":"Shin","year":"2019","journal-title":"J. Clin. Densitom."},{"key":"ref_66","doi-asserted-by":"crossref","unstructured":"Ghebre, Y.T. (2020). Proton Pump Inhibitors and Osteoporosis: Is Collagen a Direct Target?. Front. Endocrinol., 11.","DOI":"10.3389\/fendo.2020.00473"},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"696","DOI":"10.1007\/s00223-021-00882-9","article-title":"Proton Pump Inhibitors Inhibit PHOSPHO1 Activity and Matrix Mineralisation In Vitro","volume":"109","author":"Staines","year":"2021","journal-title":"Calcif. Tissue Int."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1002\/PHAR.1007","article-title":"Fracture risk and bone mineral density reduction associated with proton pump inhibitors","volume":"32","author":"Lau","year":"2012","journal-title":"Pharmacotherapy"},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"547","DOI":"10.1177\/0194599816648298","article-title":"Adverse Event Reporting for Proton Pump Inhibitor Therapy: An Overview of Systematic Reviews","volume":"155","author":"Abramowitz","year":"2016","journal-title":"Otolaryngol. Head. Neck Surg."},{"key":"ref_70","first-page":"4899","article-title":"Bone fracture and the interaction between bisphosphonates and proton pump inhibitors: A meta-analysis","volume":"8","author":"Yang","year":"2015","journal-title":"Int. J. Clin. Exp. Med."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"115113","DOI":"10.1016\/j.bone.2019.115113","article-title":"Psychotropic medications and proton pump inhibitors and the risk of fractures in the teriparatide versus risedronate VERO clinical trial","volume":"130","author":"Kendler","year":"2020","journal-title":"Bone"},{"key":"ref_72","doi-asserted-by":"crossref","unstructured":"Signorelli, S.S., Scuto, S., Marino, E., Giusti, M., Xourafa, A., and Gaudio, A. (2019). Anticoagulants and Osteoporosis. Int. J. Mol. Sci., 20.","DOI":"10.3390\/ijms20215275"},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1016\/j.thromres.2006.10.025","article-title":"The effects of heparin and low molecular weight heparins on bone","volume":"122","author":"Rajgopal","year":"2008","journal-title":"Thromb. Res."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1055\/s-0038-1642376","article-title":"Comparison of subcutaneous unfractionated heparin with a low molecular weight heparin (Fragmin) in patients with venous thromboembolism and contraindications to coumarin","volume":"71","author":"Monreal","year":"1994","journal-title":"Thromb. Haemost."},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"947","DOI":"10.1007\/s11606-016-3603-8","article-title":"Effects of Long-Term Low-Molecular-Weight Heparin on Fractures and Bone Density in Non-Pregnant Adults: A Systematic Review with Meta-Analysis","volume":"31","author":"Phua","year":"2016","journal-title":"J. Gen. Intern. Med."},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1007\/s11657-020-00770-z","article-title":"Trabecular bone score (TBS) and bone mineral density in patients with long-term therapy with warfarin","volume":"15","author":"Marques","year":"2020","journal-title":"Arch. Osteoporos."},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"1750","DOI":"10.1001\/archinte.159.15.1750","article-title":"Long-term use of oral anticoagulants and the risk of fracture","volume":"159","author":"Caraballo","year":"1999","journal-title":"Arch. Intern. Med."},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1001\/archinte.166.2.241","article-title":"Risk of osteoporotic fracture in elderly patients taking warfarin: Results from the National Registry of Atrial Fibrillation 2","volume":"166","author":"Gage","year":"2006","journal-title":"Arch. Intern. Med."},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"304","DOI":"10.1007\/s11606-018-4758-2","article-title":"A Systematic Review and Meta-analysis of the Association Between Vitamin K Antagonist Use and Fracture","volume":"34","author":"Fiordellisi","year":"2019","journal-title":"J. Gen. Intern. Med."},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"977","DOI":"10.1007\/s00380-017-0950-2","article-title":"Effects on bone metabolism markers and arterial stiffness by switching to rivaroxaban from warfarin in patients with atrial fibrillation","volume":"32","author":"Namba","year":"2017","journal-title":"Heart Vessels"},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"116000","DOI":"10.1016\/j.bone.2021.116000","article-title":"Bone density and quality in patients treated with direct-acting oral anticoagulants versus warfarin","volume":"150","author":"Nalevaiko","year":"2021","journal-title":"Bone"},{"key":"ref_82","doi-asserted-by":"crossref","unstructured":"Tsai, S.H.L., Hu, C.W., Shao, S.C., Tischler, E.H., Obisesan, O.H., Vervoort, D., Chen, W.C., Hu, J.R., and Kuo, L.T. (2022). Comparative Risks of Fracture Among Direct Oral Anticoagulants and Warfarin: A Systematic Review and Network Meta-Analysis. Front. Cardiovasc. Med., 9.","DOI":"10.3389\/fcvm.2022.896952"},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"606","DOI":"10.1016\/j.bone.2012.05.018","article-title":"Antidepressant medications and osteoporosis","volume":"51","author":"Rizzoli","year":"2012","journal-title":"Bone"},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1016\/j.biopsych.2012.11.003","article-title":"Selective serotonin reuptake inhibitors inhibit human osteoclast and osteoblast formation and function","volume":"74","author":"Hodge","year":"2013","journal-title":"Biol. Psychiatry"},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"43","DOI":"10.11005\/jbm.2018.25.1.43","article-title":"The Effect of Antidepressants on Mesenchymal Stem Cell Differentiation","volume":"25","author":"Kruk","year":"2018","journal-title":"J. Bone Metab."},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1007\/s00223-018-0398-0","article-title":"Selective Serotonin Reuptake Inhibitors (SSRIs) and Markers of Bone Turnover in Men","volume":"103","author":"Williams","year":"2018","journal-title":"Calcif. Tissue Int."},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1016\/j.bone.2016.05.003","article-title":"Effects of antidepressants on postmenopausal bone loss-A 5-year longitudinal study from the OSTPRE cohort","volume":"89","author":"Rauma","year":"2016","journal-title":"Bone"},{"key":"ref_88","doi-asserted-by":"crossref","first-page":"38564","DOI":"10.52965\/001c.38564","article-title":"The use of antidepressants is linked to bone loss: A systematic review and metanalysis","volume":"14","author":"Mercurio","year":"2022","journal-title":"Orthop. Rev."},{"key":"ref_89","doi-asserted-by":"crossref","first-page":"116565","DOI":"10.1016\/j.bone.2022.116565","article-title":"Association of mental disorders and psychotropic medications with bone texture as measured with trabecular bone score","volume":"165","author":"Hafizi","year":"2022","journal-title":"Bone"},{"key":"ref_90","doi-asserted-by":"crossref","first-page":"641","DOI":"10.1001\/jamapsychiatry.2017.0449","article-title":"Association of Mental Disorders and Related Medication Use with Risk for Major Osteoporotic Fractures","volume":"74","author":"Bolton","year":"2017","journal-title":"JAMA Psychiatry"},{"key":"ref_91","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1007\/s00198-012-2015-9","article-title":"Relationship between use of antidepressants and risk of fractures: A meta-analysis","volume":"24","author":"Rabenda","year":"2013","journal-title":"Osteoporos. Int."},{"key":"ref_92","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s00223-020-00688-1","article-title":"Medications as a Risk Factor for Fragility Hip Fractures: A Systematic Review and Meta-analysis","volume":"107","author":"Mortensen","year":"2020","journal-title":"Calcif. Tissue Int."},{"key":"ref_93","doi-asserted-by":"crossref","first-page":"314","DOI":"10.1007\/s11102-020-01041-3","article-title":"Hyperprolactinemia and bone","volume":"23","author":"Doga","year":"2020","journal-title":"Pituitary"},{"key":"ref_94","doi-asserted-by":"crossref","first-page":"109941","DOI":"10.1016\/j.pnpbp.2020.109941","article-title":"Antipsychotic-induced Hyperprolactinemia in aging populations: Prevalence, implications, prevention and management","volume":"101","author":"Labad","year":"2020","journal-title":"Prog. Neuropsychopharmacol. Biol. Psychiatry"},{"key":"ref_95","doi-asserted-by":"crossref","unstructured":"Li, P., Wang, Y., Liu, X., Zhou, Z., Wang, J., Zhou, H., Zheng, L., and Yang, L. (2019). Atypical antipsychotics induce human osteoblasts apoptosis via Wnt\/\u03b2-catenin signaling. BMC Pharmacol. Toxicol., 20.","DOI":"10.1186\/s40360-019-0287-9"},{"key":"ref_96","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1016\/j.schres.2016.06.034","article-title":"Relationship between long-term use of a typical antipsychotic medication by Chinese schizophrenia patients and the bone turnover markers serum osteocalcin and \u03b2-CrossLaps","volume":"176","author":"Zhang","year":"2016","journal-title":"Schizophr. Res."},{"key":"ref_97","doi-asserted-by":"crossref","unstructured":"Azimi Manavi, B., Stuart, A.L., Pasco, J.A., Hodge, J.M., Samarasinghe, R.M., Weerasinghe, D.K., and Williams, L.J. (2023). Use of antipsychotic medication and its relationship with bone mineral density: A population-based study of men and women. Front. Psychiatry, 13.","DOI":"10.3389\/fpsyt.2022.1004366"},{"key":"ref_98","doi-asserted-by":"crossref","first-page":"101694","DOI":"10.1016\/j.bonr.2023.101694","article-title":"Antipsychotic medication use in association with quantitative heel ultrasound (QUS)","volume":"18","author":"Mohebbi","year":"2023","journal-title":"Bone Rep."},{"key":"ref_99","doi-asserted-by":"crossref","first-page":"1216","DOI":"10.4088\/JCP.14m09098","article-title":"Antipsychotic treatment and the risk of hip fracture in subjects with schizophrenia: A 10-year population-based case-control study","volume":"76","author":"Wu","year":"2015","journal-title":"J. Clin. Psychiatry"},{"key":"ref_100","doi-asserted-by":"crossref","first-page":"1167","DOI":"10.1007\/s00198-016-3881-3","article-title":"Use of antipsychotics increases the risk of fracture: A systematic review and meta-analysis","volume":"28","author":"Lee","year":"2017","journal-title":"Osteoporos. Int."},{"key":"ref_101","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1097\/YIC.0000000000000221","article-title":"Antipsychotic drug exposure and risk of fracture: A systematic review and meta-analysis of observational studies","volume":"33","author":"Papola","year":"2018","journal-title":"Int. Clin. Psychopharmacol."},{"key":"ref_102","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1159\/000430340","article-title":"Lithium Chloride Modulates Adipogenesis and Osteogenesis of Human Bone Marrow-Derived Mesenchymal Stem Cells","volume":"37","author":"Tang","year":"2015","journal-title":"Cell Physiol. Biochem."},{"key":"ref_103","doi-asserted-by":"crossref","unstructured":"Wong, S.K., Chin, K.Y., and Ima-Nirwana, S. (2020). The Skeletal-Protecting Action and Mechanisms of Action for Mood-Stabilizing Drug Lithium Chloride: Current Evidence and Future Potential Research Areas. Front. Pharmacol., 11.","DOI":"10.3389\/fphar.2020.00430"},{"key":"ref_104","doi-asserted-by":"crossref","first-page":"454","DOI":"10.1001\/jamapsychiatry.2022.0337","article-title":"Association of Lithium Treatment With the Risk of Osteoporosis in Patients With Bipolar Disorder","volume":"79","author":"Rohde","year":"2022","journal-title":"JAMA Psychiatry"},{"key":"ref_105","doi-asserted-by":"crossref","first-page":"257","DOI":"10.1007\/s00198-018-4745-9","article-title":"Lithium use and risk of fracture: A systematic review and meta-analysis of observational studies","volume":"30","author":"Liu","year":"2019","journal-title":"Osteoporos. Int."},{"key":"ref_106","doi-asserted-by":"crossref","first-page":"1670","DOI":"10.2337\/dc07-0554","article-title":"Thiazolidinedione therapy gets complicated: Is bone loss the price of improved insulin resistance?","volume":"30","author":"Schwartz","year":"2007","journal-title":"Diabetes Care"},{"key":"ref_107","doi-asserted-by":"crossref","first-page":"232","DOI":"10.1002\/jcb.21994","article-title":"PPARgamma2 nuclear receptor controls multiple regulatory pathways of osteoblast differentiation from marrow mesenchymal stem cells","volume":"106","author":"Shockley","year":"2009","journal-title":"J. Cell Biochem."},{"key":"ref_108","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1007\/s12018-012-9129-7","article-title":"Safety of Anti-Diabetic Therapies on Bone","volume":"11","year":"2013","journal-title":"Clin. Rev. Bone Miner. Metab."},{"key":"ref_109","doi-asserted-by":"crossref","first-page":"845","DOI":"10.2337\/dc07-2270","article-title":"Rosiglitazone-associated fractures in type 2 diabetes: An Analysis from A Diabetes Outcome Progression Trial (ADOPT)","volume":"31","author":"Kahn","year":"2008","journal-title":"Diabetes Care"},{"key":"ref_110","doi-asserted-by":"crossref","first-page":"2929","DOI":"10.1007\/s00125-012-2668-0","article-title":"Hospitalised hip fracture risk with rosiglitazone and pioglitazone use compared with other glucose-lowering drugs","volume":"55","author":"Colhoun","year":"2012","journal-title":"Diabetologia"},{"key":"ref_111","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1016\/j.bone.2014.08.010","article-title":"Risk of fracture with thiazolidinediones: An updated meta-analysis of randomized clinical trials","volume":"68","author":"Zhu","year":"2014","journal-title":"Bone"},{"key":"ref_112","doi-asserted-by":"crossref","first-page":"2238","DOI":"10.1007\/s00125-015-3660-2","article-title":"The effect of thiazolidinediones on bone mineral density and bone turnover: Systematic review and meta-analysis","volume":"58","author":"Billington","year":"2015","journal-title":"Diabetologia"},{"key":"ref_113","doi-asserted-by":"crossref","unstructured":"Smieszek, A., Tomaszewski, K.A., Kornicka, K., and Marycz, K. (2018). Metformin Promotes Osteogenic Differentiation of Adipose-Derived Stromal Cells and Exerts Pro-Osteogenic Effect Stimulating Bone Regeneration. J. Clin. Med., 7.","DOI":"10.3390\/jcm7120482"},{"key":"ref_114","doi-asserted-by":"crossref","first-page":"1167","DOI":"10.1007\/s00198-019-04948-1","article-title":"Metformin use and risk of fracture: A systematic review and meta-analysis of observational studies","volume":"30","author":"Sadeghi","year":"2019","journal-title":"Osteoporos. Int."},{"key":"ref_115","doi-asserted-by":"crossref","first-page":"299","DOI":"10.1530\/EJE-20-0507","article-title":"Metformin use is associated with a lower risk of osteoporosis\/vertebral fracture in Taiwanese patients with type 2 diabetes mellitus","volume":"184","author":"Tseng","year":"2021","journal-title":"Eur. J. Endocrinol."},{"key":"ref_116","doi-asserted-by":"crossref","first-page":"8874272","DOI":"10.1155\/2020\/8874272","article-title":"DPP4 Activities Are Associated with Osteopenia\/Osteoporosis and Fracture Risk in Newly Diagnosed Type 2 Diabetes","volume":"2020","author":"Qiu","year":"2020","journal-title":"Int. J. Endocrinol."},{"key":"ref_117","doi-asserted-by":"crossref","first-page":"E447","DOI":"10.1152\/ajpendo.00217.2014","article-title":"DPP IV inhibitor treatment attenuates bone loss and improves mechanical bone strength in male diabetic rats","volume":"307","author":"Glorie","year":"2014","journal-title":"Am. J. Physiol. Endocrinol. Metab."},{"key":"ref_118","doi-asserted-by":"crossref","first-page":"2474","DOI":"10.2337\/dc11-1099","article-title":"Dipeptidyl peptidase-4 inhibitors and bone fractures: A meta-analysis of randomized clinical trials","volume":"34","author":"Monami","year":"2011","journal-title":"Diabetes Care"},{"key":"ref_119","doi-asserted-by":"crossref","first-page":"R29","DOI":"10.1530\/JOE-17-0278","article-title":"Novel skeletal effects of glucagon-like peptide-1 (GLP-1) receptor agonists","volume":"236","author":"Mabilleau","year":"2018","journal-title":"J. Endocrinol."},{"key":"ref_120","doi-asserted-by":"crossref","first-page":"589","DOI":"10.1007\/s00592-025-02468-5","article-title":"Effect of GLP-1 receptor agonists on bone mineral density, bone metabolism markers, and fracture risk in type 2 diabetes: A systematic review and meta-analysis","volume":"62","author":"Tan","year":"2025","journal-title":"Acta Diabetol."},{"key":"ref_121","doi-asserted-by":"crossref","unstructured":"Chen, M., Lyu, Y., Zhao, J., Han, X., Huang, T., Yang, T., and Zhou, Y. (2025). Use of GLP-1 receptor agonist and risk of osteoporosis among patients with type 2 diabetes: A real-world study. Front. Endocrinol., 16.","DOI":"10.3389\/fendo.2025.1586589"},{"key":"ref_122","doi-asserted-by":"crossref","first-page":"2849","DOI":"10.1210\/jc.2015-1884","article-title":"SGLT2 Inhibitors May Predispose to Ketoacidosis","volume":"100","author":"Taylor","year":"2015","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_123","doi-asserted-by":"crossref","first-page":"2013","DOI":"10.1007\/s00198-023-06908-2","article-title":"Effect of SGLT2 inhibitors on fractures, BMD, and bone metabolism markers in patients with type 2 diabetes mellitus: A systematic review and meta-analysis","volume":"34","author":"Wang","year":"2023","journal-title":"Osteoporos. Int."},{"key":"ref_124","doi-asserted-by":"crossref","first-page":"2117","DOI":"10.1056\/NEJMoa1504720","article-title":"Empagliflozin, Cardiovascular Outcomes, and Mortality in Type 2 Diabetes","volume":"373","author":"Zinman","year":"2015","journal-title":"N. Engl. J. Med."},{"key":"ref_125","doi-asserted-by":"crossref","first-page":"e2130762","DOI":"10.1001\/jamanetworkopen.2021.30762","article-title":"Association of Sodium-Glucose Cotransporter-2 Inhibitors with Fracture Risk in Older Adults with Type 2 Diabetes","volume":"4","author":"Zhuo","year":"2021","journal-title":"JAMA Netw. Open"},{"key":"ref_126","doi-asserted-by":"crossref","first-page":"1170","DOI":"10.1007\/s00125-017-4283-6","article-title":"Diabetes, bone and glucose-lowering agents: Clinical outcomes","volume":"60","author":"Schwartz","year":"2017","journal-title":"Diabetologia"},{"key":"ref_127","doi-asserted-by":"crossref","first-page":"527","DOI":"10.1007\/s40266-013-0081-0","article-title":"Sulfonylureas and risk of falls and fractures: A systematic review","volume":"30","author":"Lapane","year":"2013","journal-title":"Drugs Aging"},{"key":"ref_128","doi-asserted-by":"crossref","first-page":"1292","DOI":"10.1007\/s00125-005-1786-3","article-title":"Relative fracture risk in patients with diabetes mellitus, and the impact of insulin and oral antidiabetic medication on relative fracture risk","volume":"48","author":"Vestergaard","year":"2005","journal-title":"Diabetologia"},{"key":"ref_129","doi-asserted-by":"crossref","first-page":"296","DOI":"10.1016\/j.cell.2010.06.003","article-title":"Insulin signaling in osteoblasts integrates bone remodeling and energy metabolism","volume":"142","author":"Ferron","year":"2010","journal-title":"Cell"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/3\/993\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,27]],"date-time":"2026-01-27T09:43:24Z","timestamp":1769507004000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/3\/993"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,26]]},"references-count":129,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2026,2]]}},"alternative-id":["jcm15030993"],"URL":"https:\/\/doi.org\/10.3390\/jcm15030993","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,26]]}}}