Acid Reflux Drugs May Up Fractures
Osteoporosis Fractures May Be More Common in People Who Use Proton Pump Inhibitors for at Least 7 Years
Aug. 11, 2008 -- Using acid reflux drugs called proton pump
inhibitors for at least seven years may be linked to increased risk of
That news comes from a Canadian study of proton pump inhibitors (PPIs) and
osteoporosis-related fractures. PPIs are a class of drugs that include Aciphex, Nexium, Prevacid, Prilosec, and Protonix
The study shows a link between long-term use of proton pump inhibitors and
greater likelihood of osteoporosis-related fractures of the hip, wrist, or
But that association took years to appear, and the study doesn't prove that
PPIs were to blame for any fractures. Makers of PPIs tell WebMD they haven't seen
any signs of increased osteoporosis-related fracture risk in people using their
More research is needed; meanwhile, patients and their doctors should
revisit the risks and benefits of long-term PPI use, according to an editorial
published with the study in the Canadian Medical Association's journal,
PPIs and Osteoporosis Fractures
The study included 63,000 adults aged 50 and older in Manitoba, Canada,
including nearly 15,300 who sustained an osteoporosis-related fracture of the
hip, spine, or wrist from 1996 to 2004.
The researchers -- who included the University of Manitoba's Laura
Targownik, MD, MSHS -- checked participants' prescription records.
People who suffered an osteoporosis-related fracture were almost twice as
likely to have used a PPI for at least seven years. Using PPIs for six or fewer
years wasn't linked to fracture risk.
Hip fracture risk may have started earlier. People with hip fractures were
62% more likely to have used a PPI for at least five years. Briefer use of PPIs
wasn't associated with hip fracture risk.
It's not clear how PPIs might increase fracture risk, but it may be that by
inhibiting stomach acid, PPIs speed up bone mineral loss, Targownik's team
speculates. But the study doesn't prove that.
The researchers considered many factors, including participants' other prescriptions, medical history, and income. Still, they
can't rule out the possibility that they missed other influences.
Benefits of PPIs vs. Risks
Long-term PPI use and fracture risk have been linked in previous
That association "is certainly a strong basis for encouraging further
investigation," write the editorialists, who included J. Brent Richards,
MD, of Canada's McGill University.
What are patients to do in the meantime? Talk to their doctors, the
"Certainly, at one extreme, such as in patients with bleeding ulcers, the beneficial effects may far outweigh the risks
associated with fractures," the editorial states. "At the other
extreme, liberal prescription of proton pump inhibitors for nebulous disorders
for extended periods of time is likely worth revisiting."
Targownik's study doesn't specify which PPIs the patients took. So WebMD
contacted the makers of all
prescription brand-name PPIs in the U.S. -- Aciphex, Nexium, Prevacid,
Prilosec, and Protonix -- for their feedback on the study.