CHICAGO - Taking such popular heartburn drugs as Nexium, Prevacid or
Prilosec for a year or more can raise the risk of a broken hip markedly in
people over 50, a large study in Britain found.
The study raises questions about the safety of some of the most widely
used and heavily promoted prescription drugs on the market, taken by
millions of people.
The researchers speculated that when the drugs reduce acid in the
stomach, they also make it more difficult for the body to absorb bone-
building calcium. That can lead to weaker bones and fractures.
Hip fractures in the elderly often lead to life-threatening complications.
As a result, doctors should make sure patients have good reason to stay
on heartburn drugs long term, said study co-author Dr. Yu-Xiao Yang of
the University of Pennsylvania School of Medicine.
“The general perception is they are relatively harmless,” Yang said. “They
often are used without a clear or justified indication for the treatment.”
Some people find relief from heartburn with over-the-counter antacids
such as Tums, Rolaids and Maalox. For others, these medicines do not
work well. Moreover, heartburn can be more than a source of discomfort.
People with chronic heartburn can develop painful ulcers in the
esophagus, and in rare cases, some can end up with damage that can
lead to esophageal cancer.
Dr. Sandra Dial of McGill University in Montreal, who was not involved in
the study but has done similar research, said patients should discuss the
risks and benefits with their doctors and taper off their use of these
medicines if they can.
Nexium, Prevacid and Prilosec are members of a class of drugs known as
proton pump inhibitors. The study found a similar but smaller risk of hip
fractures for another class of acid-fighting drugs called H2 blockers.
Those drugs include Tagamet and Pepcid.
The study, published in Wednesday’s Journal of the American Medical
Association, looked at medical records of more than 145,000 patients in
England, where a large electronic database of records is available for
research. The average age of the patients was 77.
The patients who used proton pump inhibitors for more than a year had a
44 percent higher risk of hip fracture than nonusers. The longer the
patients took the drugs, the higher their risk.
The biggest risk was seen in people who took high doses of the drugs for
more than a year. That group had a 2½ times greater risk of hip fractures
than nonusers.
Yang said that for every 1,262 elderly patients treated with the drugs for
more than a year, there would be one additional hip fracture a year
attributable to the drugs. For every 336 elderly patients treated for more
than a year with high doses, there would be one extra hip fracture a year
attributable to the drugs.
Dr. Doug Levine of AstraZeneca PLC, which makes Nexium and Prilosec,
said the study does not prove that proton pump inhibitors cause hip
fractures. It merely suggests a potential association, he said, adding that
doctors need to monitor their patients for proper dosage and watch how
long they take the drugs.
Dr. Alan Buchman of Northwestern University, who was not involved in
the research, said the study should not change medical practice, since
doctors already should be monitoring the bone density of elderly people
taking the drugs and recommending calcium-rich diets to all patients.
“Most people are not taking enough calcium to start with,” he said. He
also wondered if a similar result would have been found in a sunny
climate, because vitamin D from sunshine helps with calcium absorption.
Also, Buchman said it not known whether the acid-fighting drugs prevent
esophageal cancer. He said the risk of esophageal cancer has been
exaggerated in the marketing of these drugs.
“I think the risk has been overplayed and scared the community,”
Buchman said.
Heartburn medicines are heavily are advertised in “Ask your doctor about
...” commercials in this country, particularly during the evening news.
Nexium is the second-biggest-selling drug in the world, behind the
cholesterol medicine Lipitor, with global sales totaling .6 billion last
year, according to IMS Health, which tracks drug sales.
Yang and his co-authors disclosed in the paper that they have worked as
consultants and received speaking fees from companies making acid-
fighting drugs. The study was funded by the National Institutes of Health
and the American Gastroenterological Association/GlaxoSmithKline Glaxo
Institute for Digestive Health.
Men in the study had a higher drug-associated risk of hip fracture than
women, possibly because women may be more aware of osteoporosis and
may get more calcium in their diets, Yang said. He plans more research
on whether calcium-rich diets or calcium supplements can prevent the
problemI heard about this a few months ago, and asked my PCP because I have been on Protonix for about 2 years and am still taking it. I didn't want any additional bone problems considering the joint issues and the spine issues I have. She really felt it was a small risk for me and that it was more of a risk not to take the Protonix. I thought she was kind of dismissive of the idea, but she also has RA, so I know she understands. I'm still not feeling great about it.
Wow, I hate hearing this.
I have been on Prevacid for about 4 years. It is the only way I can tolerate all the drugs I have to take. If I skip it, I get horrible heartburn and acid reflux.
Just one more thing to worry about. I have had IBS all my life and dealt with it pretty well, but the heartburn and gerd that happens with the meds is really hard to deal with for me. I wish there were some kind of alternative. I guess I will ask the Doc his opinion, but I just don't know how I will handle all the drugs without Prevacid.
jode
Yeah, i agree, i take Nexium and will not quit either. I am taking it every
The avg age in the study was 77. That is really pretty old. I wonder what else was going on with those poor people.
Gees, I don't want to go back to having acid reflux. I got away with taking nsaids for 25 years. I still need the nsaids but I don't want to go back to the miseries I was having before I started taking proton-pump inhibitors 3 years ago.
Once again stuck between a rock and a hard place.