Heartburn Drugs May Raise Risk Of Hip Problems

As reported by the Associated Press ( Study Links Heartburn Drugs, Broken Hip by Carla Johnson 12/06), a large study conducted in Britain found that taking popular heartburn drugs such as Nexium, Prevacid or Prilosec for a year or more can raise the risk of a broken hip, markedly in people over 50. 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.

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 the 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 2 1/2 times greater risk of hip fractures than nonusers.

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. But for others, those 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.

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. 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.

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 problem.

---

 Disclaimer

Information presented on this web site is designed for educational purposes only and should not be construed as medical advice. Further, product statements made have not been evaluated by the Food & Drug Administration.