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Acid Reflux Drugs May Up Fractures

Proton-pump inhibitors -- the popular drugs that fight stomach acid -- increase the risk of hip fractures, a U.S. study shows.
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WebMD Health News

Dec. 26, 2006 – Proton-pump inhibitors -- the popular drugs that fight stomach acid -- increase the risk of hip fractures, a U.S. study shows.

The drugs are Aciphex, Nexium, Prevacid, Prilosec (called Losec in Europe), and Protonix. The drugs shut down the chemical "pump" needed by stomach cells to make acid. They are very effective for treating GERD (gastrointestinal reflux disease).

That makes the acid-fighting drugs very popular. Together they rang up nearly $13 billion in U.S. sales in 2005 -- a year in which American doctors wrote more than 95 million prescriptions for the drugs. Prilosec is now available over the counter.

Now a new study shows that when taken long term the drugs may have a side effect: hip fracture. People over age 50 who take the drugs for more than one year have a 44% increased risk of breaking a hip, find University of Pennsylvania researchers Yu-Xiao Yang, MD, and colleagues.

Taking proton-pump inhibitors at higher doses -- and for longer periods -- dramatically increases the risk. Long-term, high-dose use of the drugs ups the risk of hip fracture by 245%.

"Proton-pump inhibitor therapy is associated with a significantly higher risk of hip fractures, with the highest risk seen among those receiving high-dose proton-pump-inhibitor therapy," Yang and colleagues conclude.

The findings appear in the Dec. 27 issue of The Journal of the American Medical Association.

Proton Pump Inhibitors and Calcium

Yang and colleagues analyzed medical records on patients treated in the U.K. between 1987 and 2003. The study included 13,556 patients with hip fractures and 135,386 patients without fractures.

After controlling for all variables -- including a diagnosis of GERD -- hip fractures were strongly associated with use of proton-pump inhibitors.

It's not entirely clear why this happens. Stomach acid helps the body absorb calcium, which is needed for healthy bones. But it only takes a little bit of acid to do this. That may be why Yang's team finds only a "modest" fracture risk with low doses of proton-pump inhibitors and a "much higher magnitude" risk with high doses.

It may also explain why they found no link between other types of GERD drugs and hip fracture. Other GERD treatments include histamine blockers -- referred to as H2 antagonists; they specifically block the histamine type 2 receptor, preventing histamine from stimulating acid-producing cells. H2 antagonists include Tagamet, Zantac, Axid, and Pepcid.

The researchers suggest that proton-pump inhibitors may have "an exaggerated effect" among people already at risk of osteoporosis. They urge doctors to prescribe the drugs at the lowest effective dose.

They also urge elderly patients who need high-dose, long-term treatment with proton-pump inhibitors to get more calcium. This calcium, Yang and colleagues suggest, should be consumed in the form of dairy foods. If patients take calcium supplements, they should remember to take them with a meal.

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