Antacid Drugs Increase Risk of Hip Fractures

Healthnotes Newswire (February 1, 2007)—A large population study from Great Britain has found that taking proton pump inhibitors (PPIs), a class of drugs that reduce stomach acid production, increases the risk of bone fracture. People taking higher doses are at particularly high risk.

“Osteoporotic fractures are common among the elderly population,” said Yu-Xiao Yang, MD, MSCE of the Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, and lead author of the study. “PPI therapy is widespread and may have an exaggerated effect among those at risk for osteoporosis.”

Yang and colleagues found that people over age 50 who took a PPI for more than one year had a 44% increased risk of breaking a hip. Those who took the drugs at higher doses and for longer periods more than doubled their risk.

PPIs work by blocking the secretion of stomach acid (hydrochloric acid, or HCl) by specialized cells in the stomach lining. Decreasing the amount of HCl in the stomach aids in the healing of ulcers and effectively reduces pain from indigestion and heartburn. This has made the drugs enormously popular. The problem is that adequate HCl is needed for the absorption of nutrients, especially calcium. By impairing calcium absorption, these drugs deprive the body of a mineral that is required to maintain bone mineral density and prevent osteoporosis.

PPIs include the drugs Aciphex (rabeprazole sodium), Nexium (esomeprazole magnesium), Prevacid (lansoprazole), Prilosec (omeprazole), and Protonix (pantoprazole sodium). They are primarily used to treat gastrointestinal reflux disease (GERD), commonly known as acid reflux, and sour belches. US doctors write nearly 100 million prescriptions for these drugs each year. The leader among these drugs, Prilosec, is now available over the counter.

Yang and colleagues analyzed medical records of people treated between 1987 and 2003. The study included 13,556 patients with hip fractures and 135,386 patients without fractures. After controlling for various factors that might influence the results, hip fractures were strongly associated with use of PPIs. “For elderly patients who require long-term and particularly high-dose PPI therapy, it may be prudent to reemphasize [the need for] increased calcium intake,” concluded Dr. Yang. Dairy foods, such as milk and yogurt, and leafy green vegetables are good sources calcium. Calcium supplements are best absorbed when they also contain vitamin D, and should be taken with food.

(JAMA 2006;296:2947–53)

Jeremy Appleton, ND, CNS, is a licensed naturopathic physician, certified nutrition specialist, and published author. Dr. Appleton was the Nutrition Department Chair at the National College of Naturopathic Medicine, has served on the faculty at Bastyr University of Natural Health Sciences, and is a former Healthnotes Senior Science Editor and a founding contributor to Healthnotes Newswire. He has worked extensively in scientific and regulatory affairs in the supplement industry and is now a consultant through his company Praxis Natural Products Consulting and Wellness Services.

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