DIMP

Drug-Induced Bone Disease
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Synonyms	N/A
Pronounce	N/A
Specialty	N/A
Symptoms	Bone pain, fractures, osteoporosis
Complications	Increased risk of fractures
Onset	Varies depending on drug exposure
Duration	Chronic
Types	N/A
Causes	Medications such as glucocorticoids, antiepileptics, and others
Risks	Long-term medication use, high doses
Diagnosis	Clinical evaluation, bone density tests
Differential diagnosis	N/A
Prevention	N/A
Treatment	Medication adjustment, supplements, lifestyle changes
Medication	N/A
Prognosis	Variable, depending on management
Frequency	N/A
Deaths	N/A

Drug-Induced Bone Disease (DIBD) refers to a spectrum of bone disorders that arise as a consequence of the use of certain medications. These disorders can include osteoporosis, osteomalacia, and increased risk of bone fractures.

Pathophysiology

DIBD occurs when medications interfere with normal bone metabolism, leading to decreased bone density and structural integrity. The mechanisms can vary depending on the drug involved:

• Glucocorticoids: These drugs can lead to decreased bone formation and increased bone resorption, resulting in glucocorticoid-induced osteoporosis.
• Antiepileptic drugs: Some antiepileptics can alter vitamin D metabolism, leading to osteomalacia.
• Proton pump inhibitors: Long-term use can impair calcium absorption, contributing to bone density loss.

Common Drugs Involved

Several classes of drugs are known to contribute to DIBD:

• Glucocorticoids (e.g., prednisone)
• Antiepileptic drugs (e.g., phenytoin, carbamazepine)
• Proton pump inhibitors (e.g., omeprazole)
• Aromatase inhibitors (used in breast cancer treatment)
• Thiazolidinediones (used in diabetes management)

Clinical Presentation

Patients with DIBD may present with:

• Bone pain
• Increased incidence of fractures, particularly in the vertebrae and hips
• Decreased bone mineral density on dual-energy X-ray absorptiometry (DEXA) scans

Diagnosis

Diagnosis of DIBD involves:

• Detailed medical history to identify drug exposure
• Physical examination
• Bone density testing using DEXA
• Laboratory tests to assess calcium, phosphate, and vitamin D levels

Management

Management strategies for DIBD include:

• Discontinuation or dose reduction of the offending drug, if possible
• Use of bisphosphonates or denosumab to increase bone density
• Supplementation with calcium and vitamin D
• Lifestyle modifications such as weight-bearing exercises

Prognosis

The prognosis of DIBD depends on the ability to modify the drug regimen and the effectiveness of interventions to improve bone health. Early detection and management are crucial to prevent fractures and maintain quality of life.

Prevention

Preventive measures include:

• Regular monitoring of bone density in patients on long-term medication regimens known to affect bone health
• Prophylactic use of bone-protective agents in high-risk patients

Also see

• Osteoporosis
• Osteomalacia
• Bone density
• Glucocorticoid-induced osteoporosis