MONDAY, May 9 (HealthDay News) -- Reinforcing U.S. health
officials' concerns, new Korean research suggests that long-term
use of popular heartburn drugs such as Prilosec, Prevacid and
Nexium is linked to an increased risk of fractures.
Scientists conducting a meta-analysis of 11 studies published
between 1997 and 2011 found that proton pump inhibitors (PPIs),
which reduce stomach acid production, were associated with a 29
percent increased risk of fracture. This included a 31 percent
higher risk of hip fractures and a 54 percent heightened risk of
Another class of heartburn drugs known as H2-receptor
antagonists or H2 blockers -- which include brand names such as
Zantac and Pepcid -- were not significantly linked to fracture
risk, according to the study authors. H2 blockers, however, are
less powerful than PPIs at suppressing acid production, blocking
only about 70 percent rather than the estimated 98 percent that can
be blocked by PPIs.
"It is difficult to say uniformly what the absolute risk is because fracture risk shows many differences according to age, sex, race and ethnicity," said study lead author Dr. Chun-Sick Eom, a clinical instructor in the Department of Family Medicine at Hallym University Hospital in Chuncheon, Korea.
"Clinicians should carefully consider their decision to prescribe PPIs for patients at elevated risk for fracture, especially women older than 65 years of age," he added. "We recommend that drug doses be chosen thoughtfully with consideration of what is necessary to achieve desired therapeutic goals."
In addition, a subset of high-quality studies -- and studies
adjusting for at least five variables that could also influence
fracture risk -- did show an increase in fractures in people taking
H2 blockers. For this reason, the study authors also recommended
further study on that topic.
The study is published in the May/June issue of the journal
Annals of Family Medicine.
In May 2010, the U.S. Food and Drug Administration decided that
PPIs would carry a warning on their labels about their possible
fracture risk. The drugs -- which include esomeprazole (Nexium),
dexlansoprazole (Dexilant), omeprazole (Prilosec, Zegerid),
lansoprazole (Prevacid), pantoprazole (Protonix) and rabeprazole
(Aciphex) -- are used to treat stomach and small intestine ulcers,
gastro-esophageal reflux disease (GERD) and inflammation of the
Acid suppressors are the second leading medication used
worldwide, Eom said, with sales in the United States in 2005
totaling nearly $27 billion.
PPIs and H2 blockers are thought to have different effects on
bone metabolism, Eom noted, accounting for their disparate fracture
risks. PPIs may interfere with the digestive tract's ability to
absorb calcium -- a process aided by acid -- as well as the process
of new bone cell growth.
Eom acknowledged that the study was limited by lack of access to
individual data on nutrients that might have affected participants'
An editorial accompanying the study noted that the key was to
balance absolute risks and benefits -- for physicians to reduce PPI
use whenever appropriate, but not to worry about using them for
patients such as those with acute gastric ulcers or other
potentially life-threatening conditions.
Dr. David Bernstein, chief of the division of gastroenterology
at North Shore University Hospital in Manhasset, N.Y., said that
while the study was observational, it should prompt physicians to
question the ongoing need for patients to take acid-suppressing
"We need to look at it case by case," Bernstein said. "If someone has uncontrollable reflux and needs PPI therapy long-term, they're probably going to get it. They feel better, and it's easy."
But, "at some point, the doctor and patient need to think of a
different strategy -- either stop the medication or switch
medications," he added. "We should give the minimal amount for the
patient to get well, and then stop."
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