Popular heartburn drugs linked to hip fractures

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. Some people find relief from heartburn with over-the-counter antacids such as Tums and Rolaids. 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.

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 2Ã‚Â½ 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. Doctors need to monitor their patients for proper dosage and watch how long they take the drugs, Levine said.

Julia Ellwanger, a spokeswoman for TAP Pharmaceutical Products Inc., which markets Prevacid, said proton pump inhibitors' safety has been well-established by rigorous studies, and the new study does not prove or disprove a connection to hip fractures.

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.

Heartburn medicines are heavily are advertised in "Ask your doctor about ..." commercials in this country, particularly during the evening news.

Nexium is the third biggest selling drug in the world, behind the cholesterol medicine Lipitor and blood thinner Plavix, with global sales totaling $5.7 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 problem.

This one worries me. My husband has been taking one of these meds for a year or so now. He's also been on crutches for the past 3 months - maybe coincidence, maybe not. Initially he was diagnosed with osteonecrosis of the knee (literally death of the bone) and told that he had a 10% chance of healing if he stayed off it for 6-8 weeks. The alternative was likely to be total knee replacement. I can tell you, he was in excruciating pain and not looking forward to the first of quite possibly several artificial joints at the ripe old age of 50.

We've since had a second opinion, and the diagnosis was changed to bone marrow edema. His most recent MRI's show improvement, and we're very grateful that he will probably heal, albeit over a year or so. We've been trying to figure out how he managed to get into this condition, and the best we can come up with is that he fell on it in the spring and that it has slowly (largely imperceptibly) deteriorated to the point where he couldn't walk on it by mid-September. This is pretty distressing, since he had no warning of such a severe injury. This lastest news about the heartburn meds really makes me wonder whether the normal healing process of the bone was impaired by his heartburn meds. It would go a long way to explaining this stealth injury.

Living with a spouse with GERD gives me an indirect appreciation of heartburn pain. It's no picnic. However, considering what he has endured in pain and immobility in recent months, I doubt he'd trade heartburn relief for widespread joint problems.

I hate to ask, but have you guys been checked for Heliobacter Pylori?

The reason I ask is that I went through a long list of OTC and other medications for heartburn nothing would touch, and accidentally found something which provided relief within 24 hours. Not short term relief, but for a few weeks.

I smoked cigarettes up until a week ago, and would be in situations where a cigarette presented a serious safety hazard. So I took up smokeless tobacco, the kind that comes in little pouches. I was drinking coffee and had one of those in my mouth and washed the juice down with the coffee. Within 24 hours no heartburn. None.

YMMV, but this worked.

I'm not selling anything, just saying what worked for me. It is not too much to think the nicotine in tobacco juice might interfere with H. Pylori, and do so a lot cheaper than many commercially available meds out there.

I don't think so.

AIDS research is good. Eliminating the things and activities that cause AIDS would be better, but researching a cure for people that ail from it is good. I say this because I am sure that some people have inadvertently contracted HIV through no fault of their own and they deserve treatment. Homosexuals and people that shoot up heroin don't deserve treatment.

Are sure you a not green monkey?

I was treated with antibiotics about 7-8 years ago. I suffered chronic ulcer attacks...2-3 times a year. Following the treatment I haven't had another ulcer attack but my Gerd is as bad as ever. Nothing touches the heartburn...Protonix or Prilosec are the only things I've tried that help.

Hmmm. I was checked for H pylori, too, and also got a negative back, but the tobacco juice works every time if I have a relapse, usually once a year or so.

I was using S____Bandits, so maybe the wintergreen had an effect, or maybe there is another bug besides H. Pylori out there.

I had had heartburn which Maalox, Tums (extra strength), nothing OTC would touch at the time, not even for an instant.

Just hoping my experience would help someone, 'cause I know it is miserable. I had the 'burn ofor over a year until I accidentally got rid of it.

But, I do not drink alcohol, coffee is my main beverage (black, but low acid Sumatran). I do, however eat freely: Garlic, Jalapenos, and those little yellow hot peppers in the jar with no ill effects (now--not then), and do so on an almost daily basis.

I don't care what the side affects are. I don't have anymore problems with heartburn and I and convinced that my Pops would still be alive, had he had Nexium in his time.

Hip fractures in men, however, result in a 31 percent mortality rate at one year after fracture versus a rate of 17 percent in women.

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