Higher Risk of Hip Fracture With Regular Use of Powerful Antacids
< Dec. 27, 2007 > -- People taking powerful antacid drugs called proton pump inhibitors face an increased risk of hip fracture, according to a report published in the Journal of the American Medical Association(JAMA).
Common proton pump inhibitors include Aciphex®, Nexium®, Prevacid®, Prilosec® and Protonix®. They are often prescribed for stomach conditions such as gastroesophageal reflux disease (GERD).
"If you take acid-suppression medications on a chronic basis and are 50 or older, your hip fracture risk is even higher than usual," says study author Dr.Yu-Xiao Yang, an assistant professor of medicine and epidemiology at the University of Pennsylvania.
In the study, Dr. Yang's team collected data on 13,556 people with hip fractures and 135,386 healthy people, all aged 50 or older. These people were listed in the General Practice Research Database from 1987 to 2003. This database contains information on patients in the United Kingdom.
The researchers found that taking a proton pump inhibitor for more than one year increased the risk of hip fracture by 44 percent, compared with people not taking these medications.
In addition, the risk was 2.6 times higher among people who took high doses over a long period. The risk of hip fracture increased with both the dosage and the duration of proton pump inhibitor therapy, Dr. Yang's group found.
Dr. Yang speculates that these drugs hinder calcium absorption in some people. Stomach acid is needed to help the body absorb calcium, and proton pump inhibitors work by slowing the production of stomach acid.
Elderly persons who suffer a hip fracture have a death rate of 20 percent during the first year after the fracture. For those who survive this period, one in five requires nursing home care, an emergency department visit, hospitalization, surgery, and rehabilitation, all with huge health-care costs.
Dr. Yang says he thinks these drugs are prescribed too often. "Not everybody is on this medicine for good reasons," he says. "Proton pump inhibitors have been on the market for 15 years, and the general feeling is that they are safe to be taken on a chronic basis. So, they are given often without having a clear indication or without making sure the patient is benefiting from the medication."
Moreover, Dr. Yang thinks that both men and women taking prescription proton pump inhibitors should also take a calcium supplement to insure that they maintain their bone mass and lower their risk of hip fracture.
One expert thinks that people should not be overly concerned with this finding unless it is confirmed by other studies.
"This is a new observation," says Dr. Lawrence Brandt, chief of the Division of Gastroenterology at Montefiore Medical Center, in New York City. "It's exciting on the one hand, and alarming on the other hand. People should be aware that there are some data that show that there may be a higher risk of fracture."
Although Dr. Brandt agrees that these drugs are prescribed too often and used by some people for too long a time, he notes the findings should not change clinical practice yet.
"If someone doesn't need proton pump inhibitors, they shouldn't be on the drug," he says. "Proton pump inhibitors are probably one of the most abused classes of drugs in the world. So, there are a lot of people on this medication who shouldn't be on this medication."
In addition, people should only take these medications for as long as necessary to treat the condition it has been prescribed for, Dr. Brandt said. "If you have to take it for a long time, then you should also have your bone density followed once a year," he adds.
Dr. Brandt is not concerned with the safety of the over-the-counter versions of these drugs. "Most people who take drugs over-the-counter don't take them in a rigorous fashion," he says. "They take them when they need them, and their dose regimen is not going to be sufficiently compulsive and regimented that this is going to be a problem."
Always consult your physician for more information.
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GERD (gastroesophageal reflux disease) is believed to be the result of condition called hiatal hernia, which affects the lower esophageal sphincter (LES).
The typical cause of heartburn is when acid from the stomach backs up into the esophagus. The LES, a muscle located at the bottom of the esophagus, opens to let food in and closes to keep it in the stomach. When this muscle relaxes too often or for too long, acid refluxes back into the esophagus, causing heartburn.
Other lifestyle contributors to GERD may include the following:
- being overweight
- overeating
- consuming certain foods, such as citrus, peppermint, chocolate, fatty, and spicy foods
- caffeine
- alcohol
- smoking
- use of nonsteroidal anti-inflammatory (NSAIDs) drugs such as aspirin and ibuprofen
Gastritis, an inflammation of the stomach lining, may also cause heartburn and ulcer disease.
In many cases, GERD can be relieved through diet and lifestyle changes, as directed by your physician. Some ways to manage heartburn include the following:
- Monitor the medications you are taking - some may irritate the lining of the stomach or esophagus.
- Quit smoking.
- Watch food intake and limit fried and fatty foods, peppermint, chocolate, alcohol, coffee, citrus fruit and juices, and tomato products.
- Eat smaller portions.
- Avoid overeating.
- Watch consumption of alcohol.
- Do not lie down or go to bed right after a meal. Instead, wait a couple of hours.
- Lose weight, if necessary.
- Elevate the head of the bed 6 inches.
- Take an antacid or other medication, as directed by your physician.
Always consult your physician for more information.
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