Fix Your Heartburn, But Risk A Fracture?

Robert W. Griffith, MD

Many people with GERD (gastro-esophageal reflux disease, or heartburn) take a type of antacids called proton-pump inhibitors (PPIs). Examples are Nexium®, Prilosec®, and Prevacid®. They are extremely effective, and their side effects aren't usually serious. There's one snag, however. Use of PPIs may decrease the absorption of calcium, causing a decrease in bone density, which can, in turn, lead to an increased risk of fractures.

Dr Yang of the University of Pennsylvania has reported the results of a study of this in the Journal of the American Medical Association. The data came from a database run by General Practitioners in the UK. People over 50 who were users or non-users of PPIs were evaluated. There were13,500 hip fractures among the 149,000 patients included.

The likelihood of a hip fracture was 44% higher in those patients who'd been taking a PPI for a year previously. The increased risk escalated in patients who'd been prescribed long-term high-dose PPIs, up to1.65 times the non-users' risk. There was also an increased risk (60% higher) in patients who took PPIs for 4 years.

These findings lead, naturally, to recommendations that the lowest effective doses of PPIs are prescribed, and there should be a clearly defined medical indication. Those patients on long-term therapy, especially if they are older, should increase their calcium intake, preferably from a dairy source; if they take insoluble calcium supplements, these should be consumed along with a meal.

A similar analysis was done for the other major class of antacids, the histamine-2 receptor antagonists, showed a smaller but real increased risk. Use of H-2 blockers, such as Tagamet® and Pepcid®, was associated with a 23% increased risk of hip fracture, compared with non-users.

The facit? Don't reach for the antacids too readily - make sure they're needed, not dosed too highly, and not taken for too long. And take (drink) your dairy.

Source
HealthandAge Blog

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