Powerful Antacid Drugs Raise Fracture Risk

New Canadian research shows that long-term use of proton pump inhibitors for acid reflux, peptic ulcers and related disorders elevates the risk of osteoporosis-related fractures.

This is now the third large study finding an increased risk of such fractures in people who use these medications. This latest study, reported in the current issue of the Canadian Medical Association Journal, found the longest period of time from starting the drugs to seeing problems emerge.

Physicians and patients may need to curb their enthusiasm for prescribing proton pump inhibitors, which have surged in popularity, experts said.

"Almost all of us gastroenterologists and internists have become complacent about the use of these medications," said Dr. Felice Schnoll-Sussman, director of research at the Jay Monahan Center for Gastrointestinal Health, Weill Cornell Medical Center at New York Presbyterian Hospital in New York City. "This makes us all 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. Can we make some alterations in their dosing regimen? Can we switch them? Do they need to be on anything at all at this point?"

PPIs are powerful antacid drugs prescribed for peptic ulcer disease, gastroesophageal reflux disease (GERD) and other related conditions. Brand names include Aciphex, Nexium, Prevacid, Prilosec and Protonix. The drugs are often taken for indefinite periods of time.

The drugs work by inhibiting secretion of hydrochloric acid; this may affect calcium absorption in the small intestine.

The authors of this study, from University of Manitoba in Winnipeg, examined administrative claims data for 15,792 individuals over 50 who had had osteoporosis-related fractures of the hip, vertebra or wrist, then compared them with almost 50,000 controls.

Individuals who had used proton pump inhibitors for seven or more years had almost double the risk of an osteoporosis-related fracture. There was also a 62 percent increased risk of hip fracture after five or more years of using PPIs; the risk of hip fracture jumped to more than quadruple after seven or more years.

"Some people think, 'If I take PPIs, I can eat garbage all day long,' " Schnoll-Sussman said. "We need to tighten up on those patients. These medications are not without any kind of risk."

Bonnie - In this piece, I could not have said it better myself. How many more studies will it take for people to listen?