Acid Reflux Meds Linked to Hip Fractures
Long-term use could affect calcium absorption

(HealthDay News) -- Although drugs called "proton pump inhibitors" are considered the gold standard for soothing the symptoms of acid reflux, research has revealed that they also boost the risk for bone fractures.

The latest study, presented at the Digestive Disease Week 2009 meeting in Chicago, found that people with hip fractures were 30 percent more likely than those in a control group to have taken a proton pump inhibitor, or PPI, for at least two years before their fracture.

"The next step is evaluating whether taking calcium or vitamin D actually changes the risk, because we don't know for sure what the mechanism is," study author Dr. Douglas A. Corley, a gastroenterologist at Kaiser Permanente in San Francisco, told HealthDay. "The main thing right now is to be aware that there is this association."

Corley's analysis is the latest in a string of studies showing that long-term use of PPIs may be bad for the bones.

PPIs are a class of drugs prescribed to heal erosive esophagitis, treat ulcers and relieve heartburn and other symptoms of gastroesophageal reflux disease. The class includes such brand names as Nexium, Prevacid, Prilosec, Zegerid, Protonix and Aciphex.

PPIs work by reducing the production of stomach acid, helping to alleviate acid reflux symptoms such as heartburn and promote healing of the esophagus.

One expert says the latest evidence on the increased risk for osteoporosis-related fractures among PPI users is causing internists and gastroenterologists to pause and re-evaluate their prescribing decisions.

"This makes all of us take a step back and look at all the patients we have on these medications and ask whether they require still being on this medication, at this dosage, at this frequency," Dr. Felice Schnoll-Sussman, director of research at the Jay Monahan Center for Gastrointestinal Health at New York-Presbyterian Hospital in New York City, told HealthDay.

Although the reason for increased fracture risk hasn't been determined, it's believed that the drugs interfere with the body's ability to absorb calcium.

The Kaiser Permanente study involved nearly 34,000 people with hip fractures who were taking PPIs and histamine-2 receptor antagonists, another type of acid blocker. Compared with a control group of more than 130,000 people who were not on the drugs, PPI users taking a pill a day had a 30 percent increased risk of fracture. The risk jumped to 41 percent for those taking more than a pill a day.

In another large study, Canadian researchers examined claims data for nearly 16,000 people older than 50 who had osteoporosis-related hip, vertebra or wrist fractures. Compared with a control group of nearly 50,000 individuals, people who used PPIs for seven or more years had almost double the risk of fracture.

The findings, published in the Canadian Medical Association Journal, followed two other large studies that linked long-term PPI use with an increased fracture risk.

If you're taking PPIs, the National Osteoporosis Foundation recommends that you consider taking calcium citrate supplements. People on these acid-blocking medications may be better able to absorb calcium citrate, it says, because this form of calcium doesn't require stomach acid to be absorbed in the body.

On the Web

To learn more about the side effects of proton pump inhibitors, check out information from the Harvard Medical School Family Health Guide.

SOURCES: HealthDay News ; Douglas A. Corley, M.D., gastroenterologist, Kaiser Permanente, San Francisco; Felice Schnoll-Sussman, M.D., assistant professor of medicine, Weill Cornell Medical College, Cornell University, and director of research, Jay Monahan Center for Gastrointestinal Health, New York-Presbyterian Hospital, New York City; Aug. 12, 2008, Canadian Medical Association Journal; June 1, 2009, presentation, Digestive Disease Week meeting, Chicago; National Osteoporosis Foundation, Washington, D.C.
Author: Karen Pallarito
Publication Date: Sept. 30, 2009
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