In light of a new study published this week, older people may be more willing to live with a little bit of heartburn. Today’s issue of the Journal of the American Medical Assoctiation (JAMA) reports that seniors who chronically take antacids may be more susceptible to potentially dangerous hip fractures. The key finding: Anti-heartburn medication, known as proton pump inhibitors (PPIs), may work to reduce the body’s absorption of calcium, which in turn can lead to a loss of bone density. Popular PPIs include Prevacid, Nexium, Aciphex, and Protonix.
In the JAMA report, researchers led by the University of Pennsylvania’s Dr. Yu-Xiao Yang noted, “We found a significantly increased risk of hip fracture associated with long-term PPI therapy, particularly among long-term users of high-dose PPI…. Calcium malabsorption secondary to acid suppressive therapy may potentially explain the positive association. Calcium solubility has been believed to be important for its absorption. An acidic environment in the gastrointestinal tract facilitates the release of ionized calcium from insoluble calcium salts.” The team also said that “the increase in fracture risk surged from a modest level with regular-dose PPI therapy to a much higher magnitude with high-dose PPI therapy.”
The study used the United Kingdom’s General Practice Research Database (1987-2003) to examine the medical records of nearly 150,000 British patients and included 13,556 hip fracture cases and 135,386 controls. The study cohort consisted of users of PPI therapy and nonusers of acid suppression drugs who were older than 50 years. The risk of hip fracture associated with more than one year of PPI therapy was 44 percent higher. However, among those patients prescribed long-term high-dose PPIs, the risk of hip fracture was significantly more than double. The longer the duration of PPI therapy, the stronger the association between PPIs and hip fractures.
A hip fracture in seniors can have potentially devastating consequences. The mortality rate during the first year after a hip fracture is approximately 20 percent. Another 20 percent will require nursing home care. Therefore, any reduction in the incidence of hip fractures would have far-ranging financial and medical implications. The authors are urging medical professionals to be more diligent when recommending PPI therapy, even with over-the-counter medications, and to make sure they’ve explained the potential risks to patients.