When a health care provider prescribes a medicine to you, they are usually focused on just the one condition for which you sought help. They might not think about long-term consequences for other body systems.

A gastroenterologist who prescribes heartburn medicine, for example, may not warn you about its potential effect on bone density. You, however, might have to deal with the eventual impact on bone strength.

A reader sent us the following story: “My DEXA [a measure of bone density] was normal before my doctor prescribed a PPI [proton pump inhibitor] for acid reflux. After nearly a decade on these meds, another DEXA showed osteoporosis in both my spine and hips.

“Thanks to the People’s Pharmacy warnings about the risks of osteoporosis from PPIs, I had stopped taking it just before the new test. Consequently, I was not surprised at the results of my scan. I attribute it to the PPIs that were prescribed like candy back in the day.

“My entire adult life, I had done daily weight-bearing aerobic exercise. I added weightlifting and balance work in my 40s, got sufficient calcium through my diet and took supplemental vitamin D.

“After quitting the PPI, my reflux improved with healthy lifestyle changes. Recent endoscopies are normal. Unfortunately, the damage to my bones was already done.

“Because of this negative experience, I am leery of prescription drugs that physicians keep urging me to take for osteoporosis. I have researched them all. In my opinion, the available osteoporosis drug options can have some scary side effects that are not worth it for me. The Number Needed to Treat (NNT) for one person to have the benefit of not fracturing is not good enough for me to take the chance of serious side effects.

“I looked up the NNT on these drugs. If it were 1, the risk-benefit decision would be easy. But most, if not all, of these drugs have numbers in the double digits or even higher. Let’s say, as a hypothetical, that the NNT is 30. That means one person does not develop a fracture while the other 29 do. Even worse, they might have unwanted side effects. Those 29 patients would risk complications without protection against fracture. Those odds are not worth it for me.

“Ask your doctor the NNT for any drug you are prescribed for osteoporosis. You might be shocked at how only a few people treated actually benefit. Not enough doctors emphasize this fact.”

We appreciate this reader’s dilemma. Taking prescribed medication for years may well have resulted in osteoporosis. She clearly was not warned of this possibility in advance.

Another common medication that affects bones is a steroid such as prednisone or prednisolone, prescribed for asthma, COPD or serious immune system reactions.

Testosterone blockers for prostate cancer, aromatase inhibitors for breast cancer and even SSRI antidepressants can also weaken bones over time (American Journal of the Medical Sciences, January 2025).

There are many other examples of delayed adverse drug reactions. People should always find out how helpful a medicine will be for their problem (the NNT). Just as important, they should learn about serious, long-term complications.

In their column, Joe and Teresa Graedon answer letters from readers. Write to them in care of King Features, 300 W. 57th Street, 41st Floor, New York, NY 10019, or email them via their website: www.PeoplesPharmacy.com. Their newest book is “Top Screwups Doctors Make and How to Avoid Them.”