This Health Alert is intended for readers interested in learning about the prevention, diagnosis, and management of osteoporosis.
Proton pump inhibitors (PPIs) treat GERD and ulcers by limiting the production of caustic gastric acids. The problem: Gastric acids are a vital component of digestion. Blocking them may interfere with the absorption of calcium, which is essential for maintaining strong bones. By limiting calcium absorption, PPIs may put you at greater risk for developing osteoporosis. If you have osteoporosis, taking a PPI may increase your fracture risk. Here’s what you need to know …
A recent study published in the Canadian Medical Association Journal compared 15,792 people with osteoporosis who fractured a wrist, vertebra, or hip with 47,289 people who didn't have osteoporosis or a previous fracture. The researchers found that taking a PPI at least every other day turned out to be substantially more common in the osteoporosis/fracture group. In particular, people who reported using PPIs for seven years or more were four times as likely to fracture a bone. Taking PPIs for less than five years was safe, but after that, risk increased.
What does this mean for you? While doctors are taking this information seriously, it is important to note that the data come from an observational trial that followed participants over a number of years, recording and comparing their medical information. Placebo-controlled clinical trials -- the gold standard of medical proof -- have yet to test the link between PPIs and osteoporosis.
H. Franklin Herlong, M.D., Associate Professor of Medicine, Division of Gastroenterology, Johns Hopkins Bayview Medical Center, and Health After 50 Board Member, remarks, "The new information should encourage doctors to review the need for long-term PPI use and ensure the benefits continue to outweigh the potential risk.
"I'm concerned about the long-term use of PPIs, particularly for patients who have or are at increased risk for osteoporosis and people with conditions such as liver disease that interfere with their ability to utilize vitamin D and calcium. "These patients should have bone density tests and, if the tests show evidence of osteoporosis, take calcium and vitamin D supplements while continuing their PPI."
Proton Pump Inhibitors
- Omeprazole (Losec, Prilosec, Zegerid, Ocid)
- Lansaprazole (Prevacid, Zoton, Inhibitol)
- Esomeprazole (Nexium)
- Pantoprazole (Protonix, Somac, Pantoloc, Pantozol, Zurcal, PAN)
- Rabeprazole (Rabecid, Aciphex, Pariet, Rabeloc)
- Prilosec OTC (available without a prescription)
