Heartburn relief may come with a hitch. Proton pump inhibitors, the class of drugs that includes Nexium, Prilosec, Protonix, Aciphex, and Prevacid, may increase the risk of a hip fracture for those over 50.
Research published in the new issue of the Journal of the American Medical Association found that people who took such prescription antacids for more than one year were 44 percent more likely to have a hip fracture than those who didn’t take them.
“We think that calcium may be the major underlying mechanism here,” says Yu-Xiao Yang, lead researcher and assistant professor of medicine and epidemiology at the University of Pennsylvania. PPIs reduce acid production in the stomach, and because acid helps absorb calcium, Yang speculates that the drugs may hinder the body’s ability to absorb the bone-strengthening element.
Hip fractures are particularly devastating in older people, with an estimated mortality rate of 20 percent in the first year after a hip fracture. For those who survive, 1 in 5 needs nursing-home care, the researchers report.
Yang and colleagues analyzed people 50 and older in the General Practice Research Database from 1987 to 2003, a comprehensive pool of health data from patients in the United Kingdom. They assessed information on 13,556 hip fracture patients and 135,386 healthy patients, and they found that prescription PPI use was associated with greater odds of a hip fracture.
Longer-term use at higher doses made the problem worse. “There is a surge of risk when you go from a regular dose to a high dose,” says Yang. The study found that people who used PPIs for more than a year at doses above the recommended prescription strength were nearly three times as likely to have a hip fracture as nonusers.
The research also found that male long-term users of the drug were slightly more prone to fracture their hips than female long-term users. Though use of calcium supplements wasn’t measured, Yang suggests they might contribute to the gender disparity, since women over 50 commonly take calcium tablets. Yang says he has been recommending that patients on PPIs protect bone mass by boosting their calcium intake. “If you’re taking PPIs, you don’t want to be one of those people not getting enough calcium.”
Michael Schaefer, chair of the department of orthopedic surgery at Northwestern University Feinberg School of Medicine, says the study sheds new light on the complex problem of osteoporosis, the reduction of bone mass that can lead to hip fractures. “Osteoporotic hip fractures are multifactorial,” he says. While he’s not convinced this new research solves the problem, he adds that “as an orthopedist, here is something I need to be aware of.”
Schaefer tells his patients to quit smoking and increase physical activity–especially weight-bearing exercises–to combat and prevent osteoporosis. But he says he’ll now urge patients on PPIs to take extra calcium. “I’m a big believer in calcium supplementation.”