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allthingsnoisy in osteo_health

heartburn drugs may increase risk of fractures

From the Sacramento Bee:
Q: I am 55 and my mother has osteoporosis, so I know I am at increased risk for this. I take Prilosec for heartburn, and I just read that Prilosec can increase my risk of osteoporosis and fractures. Should I stop taking it?

A: You have reason for concern; a recent study published in the JAMA looked at the risk of osteoporosis and fractures in 150,000 British patients who were taking proton pump inhibitors on a regular basis (medications such as Prilosec, Nexium and Prevacid); the study found that these meds increased the risk of hip fracture. There also was an increased risk of hip fracture with less-potent acid blocker medications such as Zantac and Tagamet, although less than the first group of medications.

The results are rather significant -- people who took proton pump inhibitors for more than a year had a 44 percent higher risk of hip fractures. Higher doses of these medications were associated with higher rates of fractures.

Why do these meds contribute to fractures? Acid in the stomach is needed for the breakdown and absorption of a number of nutrients, including calcium (iron and vitamin B12 can also be affected). Presumably, these medications reduce the absorption of calcium, leading to decreased bone density and increased fracture risk. Reduced stomach acid from these meds also can increase your risk of GI infections.

What should you do if you take these medications? First and foremost, try to limit their use; consumption of these drugs has skyrocketed in the United States in the recent past with the explosion of obesity and huge portion sizes that are high in fat; being overweight increases your risk of reflux and heartburn. So don't do what that Prilosec commercial tells you to do -- say no to the chili cheese dog, eat a lowfat dinner instead, drop some of those extra pounds and you may not have to douse that fire in your stomach.

Other ways to help reduce reflux and heartburn include:

• Eating small meals and avoiding eating at least three hours before going to bed.

• Avoiding acidic foods such as citrus and tomatoes.

• Avoiding alcohol and caffeine.

• Avoiding peppermint.

• Minimizing your stress levels.

• Avoiding tight belts.

If despite making these changes, you continue to have significant GERD (gastroesophogeal reflux disease), then appropriate use of acid blocking medication may still be an appropriate option for you (chronic untreated acid reflux can increase your risk of esophageal cancer); just be sure you are getting enough calcium and vitamin D. If you continue to need these drugs on a regular basis, ask your doctor for a DEXA test, which measures your bone density and assesses your risk of fracture.

And don't forget to do some weight-bearing exercise every day!

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October 2008

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