Which of the following medications is associated with an increased risk of osteoporosis?

Valproic acid is associated with an increased risk of osteoporosis primarily because it can interfere with the metabolism of bone-related minerals and hormones. It is an anticonvulsant medication frequently prescribed for seizure disorders, bipolar disorder, and migraine prevention. Studies have demonstrated that long-term use of valproic acid can lead to decreased bone mineral density, which predisposes individuals to osteoporosis and fractures. The mechanism behind this includes its potential to impair vitamin D metabolism and calcium absorption, both of which are crucial for bone health.

In contrast, non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and aspirin, as well as acetaminophen, are generally not known to have significant long-term effects on bone density. While they can provide pain relief and may occasionally be used in the management of conditions associated with osteoporosis, such as arthritis, they do not inherently contribute to the deterioration of bone health to the extent that valproic acid does. Therefore, monitoring bone health is particularly important for individuals on valproic acid, especially with prolonged use.