Do your medications cause bone loss? Here's What You Need to Know

Written by: Professor Lesley Braun

For many people, taking medication is an important part of everyday life. Ideally, health care professionals have prescribed these medicines based on our individual needs and circumstances, and weighed up their benefits and risks.

In general, common side effects may have been discussed during the consultation or with the dispensing pharmacist. However, some medicines have a less well-known risk of affecting bone health, which is rarely discussed. 

Which Medications Cause Bone Loss?

In this article, we will discuss four common medicines that have been shown to impact bone health, so you can take active steps to mitigate that risk and not be caught unaware. 

We'll cover the following medications that may cause bone loss:

1. Glucocorticoids (also referred to as glucocorticosteroids)
2. Proton pump inhibitors (PPIs)
3. Selective Serotonin Reuptake Inhibitors (SSRIs)
4. Antiepileptic drugs

Glucocorticoids — prednisone and long-term steroid use

Oral glucocorticoids can have life-saving effects and are mainly prescribed for inflammatory diseases such as rheumatoid arthritis, systemic lupus erythematosus (SLE) and for some condition flare-ups such as asthma and inflammatory bowel disease. While they are very effective, they also come with serious side effects, which tend to be both dose and time-dependent. 

In regard to glucocorticoids and bone health, bone mineral density declines occur quickly with this drug class and are evident within the first 3 months of use. If use is continued for 12 months, up to 12% of bone mass can be lost with future losses continuing, but slowing, over time.¹ 

A meta-analysis of 42,500 people found that current or previous use of oral glucocorticoids increased the risk of fragility fractures in both men and women.² As with most medicines, the risk is dose dependent. While we can't say that prednisone causes osteoporosis, one study found that daily doses of glucocorticoids equivalent to more than 2.5 mg of prednisone were associated with an increased risk of vertebral and hip fractures.^3,4

Once people stop using the medication, risk of fracture declines over the next 12 months but does not necessarily return to baseline (before use levels).⁵ 

What should I take alongside prednisone for bone health?

Glucocorticoid medicines decrease new bone formation and increase bone resorption by a variety of mechanisms, thereby upsetting the tightly held balance of bone-building and breakdown.¹

They reduce intestinal calcium absorption and increase calcium losses via the kidneys whilst enhancing osteocyte apoptosis (programmed death of mature bone cells), leading to deterioration of the bone microarchitecture and bone mineral density. 

As a result, some professional guidelines recommend calcium supplementation to be taken alongside medications when treatment is likely to last 3 months or longer. 

Proton pump inhibitors (PPIs) — omeprazole and reflux medications 

Does omeprazole cause osteoporosis?

Proton pump inhibitors such as omeprazole are commonly bought over the counter in grocery and drug stores for heartburn, reflux and dyspepsia. They strongly reduce stomach acid and, in this way, reduce symptoms.

However, some minerals, such as calcium, require an acidic environment for absorption, so less stomach acid means less absorption. Low stomach acid also affects magnesium absorption, another mineral important in bone health. Mineral supplementation should be considered when using these medicines regularly. 

The first reports of increased fracture risk with PPI drugs were in 2006. Since then, multiple epidemiological studies (population studies) have confirmed an increased risk of fractures of the spine, hip and wrist with proton pump inhibitors. ¹ Once again, a dose-dependent effect was seen as higher doses increased the risk further. Additionally, longer exposure to this medicine (length of time used) and older age were associated with increased fracture risk.  

Selective Serotonin Reuptake Inhibitors (SSRIs) — antidepressants and bone density

Do SSRIs cause osteoporosis?

SSRIs such as Celexa and Prozac are often used as first-line therapy for depression, which is a condition affecting up to 10% of adults in the USA.⁶ SSRIs are thought to work by raising serotonin levels by blocking serotonin transporters, which normally uptake and remove it. In this way, more serotonin accumulates, and levels rise. Importantly, serotonin transporters are also found in bone cells — within osteoclasts, osteoblasts and osteocytes.¹

Blocking these receptors in the bone will eventually affect bone health and the risk of fracture. This has been confirmed in multiple meta-analyses, which have shown that use of SSRIs increases the risk of bone fracture.¹ 

One study of 5,008 adults aged 50 years and older, followed for over five years, found that daily SSRI use was associated with a two-fold increased risk of incident clinical fragility fracture. Daily use was also associated with an increased risk of falling, lower bone mineral density at the hip, and a trend towards lower bone mineral density at the spine. Similar to the other drugs discussed so far, these effects are dose dependent. 

Antiepileptic drugs — a less commonly discussed risk 

Many antiepileptic drugs, such as phenytoin, carbamazepine and valproate, affect critical minerals and are associated with increased fracture risk; however, the exact mechanism behind this result remains unclear.¹

Early studies found that drugs such as phenytoin and phenobarbital induced the liver enzyme system cytochrome P450, which led to increased degradation of vitamin D. As a result, low vitamin D levels occur, which reduces intestinal calcium absorption and, subsequently, bone strength.

Other research suggests direct inhibition of calcium absorption, regardless of vitamin D status. Regardless, many studies have confirmed increased risk of bone fractures, which is further compounded by epilepsy itself, which can affect balance and fall risk. 

A 2024 study reported that adults with epilepsy taking phenytoin had a higher associated risk of osteoporosis and multiple fragility fracture types, highlighting the importance of ongoing bone health monitoring.

A large study involving over 370,000 people found the risk was higher with higher doses and also higher with cytochrome P450 enzyme-inducing drugs (carbamazepine, oxcarbazepine, phenobarbital, phenytoin, and primidone) than for noninducing drugs (clonazepam, ethosuximide, lamotrigine, tiagabine, topiramate, valproate, and vigabatrin).⁸ As a result, it's recommended that people on long-term antiepileptic drugs should have ongoing bone mineral density and vitamin D monitoring. 

If you are currently using any of these medications, it’s wise to consult with your health care professional to develop a bone protection strategy. Targeted nutrition strategies such as calcium, vitamin D and bioactive collagen peptides like FORTIBONE may help support bone health for people at risk of fractures and bone density losses as part of a broader wellness routine.

Besides supplements and medication, other useful non-pharmacological approaches should include reduced alcohol intake and tobacco use, and regular resistance training. 

GLP-1 medications — Ozempic, Wegovy and tirzepatide

Does Ozempic® cause osteoporosis?

The relationship between Ozempic® and osteoporosis is one of the most searched bone health questions of 2025 and 2026, and the research is still evolving. Medications like Ozempic® and Wegovy® (semaglutide) are widely used for type 2 diabetes and weight management, but scientists are still learning how weight loss may affect bone over time.

In a double-blinded, randomized trial, 64 adults with increased fracture risk took semaglutide 1.0 mg or placebo for 52 weeks. The semaglutide group showed no increase in bone formation but increased bone resorption, a shift that may be partly explained by weight loss.⁹

A large retrospective study of adults 65+ with type 2 diabetes who started GLP-1RA therapy or a comparator medication between 2018 and 2022 found that GLP-1RA use was associated with an 11% higher fracture risk compared with comparator medications.¹⁰

These findings do not establish that Ozempic® causes osteoporosis directly. However, emerging research suggests that bone and muscle health deserve closer attention during substantial weight loss, particularly in individuals already at higher risk of age-related bone loss or fractures.

To avoid or not to avoid: What about GLP-1 medications and osteoporosis? 

These are important medications with significant benefits for metabolic health. But taking them without a plan to protect bone and muscle is incomplete.

That's because substantial weight loss, whether from GLP-1 medications or other causes, naturally affects lean mass. The SURMOUNT-1 trial, a landmark phase 3 study of tirzepatide, found that approximately 75% of total weight lost was from fat mass and around 25% came from lean mass, regardless of whether participants received tirzepatide or placebo.¹¹ Over 72 weeks, lean body mass declined by 10.9% in the tirzepatide group versus 2.6% in the placebo group.

This matters for bone health because muscle and bone are closely interconnected. When muscles contract during movement, they place mechanical load on bone, which helps stimulate bone maintenance and remodeling. When muscle mass decreases, that mechanical stimulus may also decline, potentially contributing to reduced bone strength over time.

That’s why adequate protein intake, resistance exercise and nutritional strategies that support bone and muscle health may become especially important during significant weight loss. For individuals using GLP-1 medications, it may be worthwhile discussing bone and muscle health support with a qualified healthcare professional as part of a broader wellness plan.

Medications & Bone Health: Key Takeaway

If you’re taking medications known to affect bone health, it’s worth discussing bone and muscle support with your healthcare provider early, particularly during significant weight loss or long-term medication use.

Resistance exercise, adequate protein intake and nutrients involved in collagen formation and bone maintenance, such as targeted bioactive collagen peptides, may all play supportive roles in maintaining musculoskeletal health over time.

Prof. Braun is an adjunct professor at Southern Cross University in Australia and the National Institute of Complementary Medicine at Western Sydney University, and lead author of five textbooks on evidence-based dietary supplement ingredients, including "Herbs and Natural Medicine: An Evidence-Based Guide", which is a well-regarded foundational reference in the complementary medicine field.

She is also a clinical trialist and has a career dedicated to advancing evidence-based integrative medicine, combined with bringing knowledge and solutions to the public.

References

1. Hant F, Bolster M. Drugs that may harm bone: mitigating the risk. Cleveland Clinic Journal of Medicine. 2016;83(4):281–288.
2. Kanis JA, Johansson H, Oden A, et al. A meta-analysis of prior corticosteroid use and fracture risk. Journal of Bone and Mineral Research. 2004;19(6):893–899.
3. Van Staa TP, Geusens P, Pols HA, de Laet C, Leufkens HG, Cooper C. A simple score for estimating the long-term risk of fracture in patients using oral glucocorticoids. QJM. 2005;98(3):191–198.
4. Van Staa TP, Leufkens HG, Abenhaim L, Zhang B, Cooper C. Oral corticosteroids and fracture risk: relationship to daily and cumulative doses. Rheumatology. 2000;39(12):1383–1389.
5. Van Staa TP, Leufkens HG, Abenhaim L, Zhang B, Cooper C. Use of corticosteroids and risk of fractures. Journal of Bone and Mineral Research. 2000;15(6):993–1000.
6. Chen F, Hahn TJ, Weintraub NT. Do SSRIs play a role in decreasing bone mineral density? Journal of the American Medical Directors Association. 2012;13(5):413–417.
7. Weatherall M, James K, Clay J, et al. Dose-response relationship for risk of non-vertebral fracture with inhaled corticosteroids. Clinical & Experimental Allergy. 2008;38(9):1451–1458.
8. Vestergaard P, Rejnmark L, Mosekilde L. Fracture risk associated with use of antiepileptic drugs. Epilepsia. 2004;45(11):1330–1337.
9. Kasher Meron M, Hornik-Lurie T, Twig G, Rotman-Pikielny P. GLP-1 receptor agonists and the risk of fragility fractures in older adults with type 2 diabetes. The Journal of Clinical Endocrinology & Metabolism. 2026. doi:10.1210/clinem/dgag056
10. Hansen MS, Wolfel EM, Jeromdesella S, et al. Once-weekly semaglutide versus placebo in adults with increased fracture risk: a randomised, double-blinded, two-centre, phase 2 trial. EClinicalMedicine. 2024;72:102624. doi:10.1016/j.eclinm.2024.102624
11. Look M, Stefanakis K, Janssen I, et al. Tirzepatide reduces lean body mass: SURMOUNT-1 DXA substudy. Diabetes, Obesity and Metabolism. 2025. doi:10.1111/dom.16378