Heartburn drugs may raise risk of broken hip
12/27/2006CHICAGO Taking popular heartburn drugs such 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 of British patients found.
The study raises questions about the safety of some of the most widely used prescription drugs on the market, taken by millions of people.
Researchers speculated that when the drugs reduce acid in the stomach, they 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 Dr. Yu-Xiao Yang of the University of Pennsylvania School of Medi-cine. He led the study, published in today s Journal of the American Medical Association.
The general perception is they are relatively harmless, Dr. Yang said. They often are used without a clear or justified indication for the treatment.
Dr. Yang said physicians should be aware of the potential risk, prescribe the lowest possible dose, and only use the drug on patients who really need it.
The findings are interesting, said Dr. Alan Buchman of Northwestern University, but the results do not prove that the drugs caused the increased risk.
Maybe they have some other problem that increases the risk for fractures, he said.
Even if the drugs are at fault, the solution may be simply to consume more calcium, either in the form of dairy products or as supplements, said Dr. Buchman, who was not involved in the study.
Drug manufacturers noted that the products have been used for more than 10 years and have been through many clinical trials without evidence of risk.
Amy Allen, a spokesman for TAP Pharmaceuticals Inc. of Lake Forest, Ill., which manufactures Prevacid, said the company has an extensive post-marketing surveillance system and has not identified a safety signal for bone fractures related to Prevacid.
Heartburn typically occurs when acid from the stomach bubbles up into the esophagus, a condition called acid reflux.
It is very painful and can cause ulcers on the lining of the esophagus. Some researchers believe it can also lead to cancer.
Some people find relief from heartburn with over-the-counter antacids such as Tums, Rolaids, and Maalox. But for others, those medicines do not work well. 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 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.
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.