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Proton Pump Inhibitors Linked to Hip Fractures

January 31, 2012 — The British Medical Journal has published the results of a study that found a 35% increased risk of hip fractures in women who took a heartburn medication of the Proton Pump Inhibitor (PPI) class for at least two years. The risk was greatest for post-menopausal women who smoke.

PPIs include some of the most popular heartburn medications in the world:

  • Aciphex (rabeprazole)
  • Dexilant (dexlansoprazole)
  • Nexium (esomeprazole)
  • Prevacid (lansoprazole)
  • Prilosec (omeprazole)
  • Protonix (pantoprazole)
  • Vimovo (naproxen/esomeprazole magnesium)
  • Zegerid (omeprazole and sodium bicarbonate)

The researchers looked at data on nearly 80,000 post-menopausal women. Of these, 893 suffered a hip fracture. The risk of hip fractures among PPI-users was 2 events per 1,000 person-years, compared with 1.5 events per 1,000 person-years among non-users. The results remained constant when controlling for body-mass-index, physical activity, and history of osteoporosis.

The study found a significant association between regular use of PPIs and hip fractures. Furthermore, the study found that the risk increased with a longer duration of PPI use.

PPIs are among the most widely-used drugs in the world. Since the U.S. Food and Drug Administration (FDA) approved their over-the-counter sale in 2003, their use has increased dramatically. In 2000, around 6.7% of women regularly used a PPI. In 2008, this number rose dramatically to 18.9% in 2008. This is a nearly three-fold increase.

The researchers said the the strengths of the study include its design, large sample size, and analysis of several risk factors that may also contribute to hip fractures. However, one draw-back was that they did not look at specific brand-names or dosages of the PPIs.

PPIs are are primarily used to treat the symptoms of heartburn and acid reflux. They do so by inhibiting the production of stomach acid. Short-term use of these medications is generally considered safe. Long-term use, however, may increase a user’s risk of suffering a hip fracture. Several studies have found a link between PPIs and hip fractures. In May 2010, the FDA warned that PPI medications may increase the risk of bone fractures (hip, wrist, and spine).

How do these medications increase the risk of hip fractures? By decreasing the amount of stomach acid, the stomach is not able to break down food as effectively. Over time, this can cause a reduction of the amount of nutrients that the body can absorb, including calcium. Nutritional deficiencies can contribute to bone weakening. PPIs also increase secretion of gastrin, which inhibits calcium absorption.

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