**1. Introduction**

Medications that cause osteoporosis are numerous and common. While helping to correct one problem, they may be putting you at greater risk of having osteoporosis. Several drugs and drug classes can decrease BMD, including thiazolidinediones, and consequently increase fracture risk; other drugs, such as selective serotonin reuptake inhibitors (SSRI), do not necessarily increase bone loss, but they may increase fracture risk, possibly resulting from an increased risk of falls due to effects on postural balance mediated by central nervous system effects. Amiodarone is a potent antiarrhythmic drug. It is a benzofuran-derived, iodine-rich compound with some structural similarity to thyroxine (T4). Amiodarone contains approximately 37% iodine by weight. Each 200-mg tablet is estimated to contain about 75 mg of organic

iodide, 8–17% of which is released as free iodide. Thyroid abnormalities have been noted in up to 14–18% of patients receiving long-term amiodarone therapy. 2010 FDA warning: proton pump inhibitors and increased fracture risk revised warning for PPI: possible increased risk of hip, wrist, and spine fractures.

Aromatase inhibitors stop the production of estrogen in postmenopausal women. Aromatase inhibitors work by blocking the enzyme aromatase, which turns the hormone androgen into small amounts of estrogen in the body.

Osteoporosis can arise as a consequence of some rheumatic diseases, as RA itself can contribute to osteoporosis through systemic inflammation; immobility and medications other than glucocorticoids like long-term use of or methotrexate that inhibits osteoblastic differentiation leading to a reduction in bone formation and an increased risk of osteopathy. Patients with IBD are more likely than the general population to experience bone loss due to malnutrition, vitamin D and calcium malabsorption and deficiency, vitamin K insufficiency, immobilization, and underlying inflammatory state.

Long use of such medications leads to decreased bone biomechanical capability and thus a decreased density of bone and an increased risk of fractures.

All patients who have been receiving such medications should undergo a DEXA scan and lateral spine X-ray to check for osteoporosis. People with fragility fractures or at high risk of developing fractures should avoid such medications. Moreover, nonpharmacological measures such as calcium/vitamin D nutrition and exercise should be encouraged. In general, Non-GCs Drug-Induced Osteoporosis is treated with the same medications that are used for general health care when the BMD (*T* score < 2) or higher.

In this chapter, we aimed to summarize most of these medicines to make them easily accessible for rheumatologists, orthopedists, and anyone else interested in managing osteoporosis (**Figure 1**).


#### **Figure 1.**

*Non-GC drug-induced osteoporosis: mode of actions with examples.*
