THE QUESTION Over-the-counter and prescription medications have become an increasingly popular way to ease chronic heartburn. One type, proton pump inhibitors (PPIs), does this by decreasing the amount of stomach acid that the body produces, but that process can also prevent the absorption of calcium. Might this affect the bones?
THIS STUDY analyzed data on 78,899 postmenopausal women (average age, 67). At the start of the study, about 7 percent of the women used PPIs (such as Nexium, Prilosec or Prevacid), increasing to 19 percent at the end, eight years later. In that time, 893 of the women broke a hip. Those who took PPIs were 35 percent more likely to have broken their hip than were women who did not use the drugs, increasing to a 51 percent greater risk if the women had ever smoked. The longer women had used PPIs, the greater their risk for a broken hip, with six to eight years of use correlating to a 55 percent greater likelihood. Two years after stopping use of PPIs, the chance of breaking a hip dropped to a risk level equal to that of someone who had never taken the medication.
WHO MAY BE AFFECTED? Postmenopausal women. Although diet and weight loss often can eliminate the need for heartburn medicine, PPIs and similar drugs are among the top-selling over-the-counter and prescription medications. Primarily used by people with chronic heartburn, gastroesophageal reflux or a peptic ulcer, PPIs are thought to do a better job of reducing stomach acid over time than antacids and drugs called histamine receptor (H2) blockers (such as Tagamet, Zantac and Pepcid), which are intended for people seeking quick relief from occasional heartburn.
CAVEATS The Food and Drug Administration decided in March that a warning label was not warranted on over-the-counter PPIs because fracture risk with short-term, low-dose was “unlikely.” Some study data came from the women’s responses on questionnaires. Data on dose and brand name were not available, nor was information on PPI use before the start of the study. The study did not evaluate risk with H2 blockers.
FIND THIS STUDY Jan. 31 online issue of BMJ. www.bmj.com.
The research described in Quick Study comes from credible, peer-reviewed journals. Nonetheless, conclusive evidence about a treatment's effectiveness is rarely found in a single study. Anyone considering changing or beginning treatment of any kind should consult with a physician.