Heartburn drugs are connected to the hip bones - calcium - Nexium Prilosec Prevacid Protonix

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Heartburn drugs are connected to the hip bones

By H. Maugh II

Times Staff Writer

http://www.latimes.com/news/science/la-sci-heartburn27dec27,0,7796672.story

Older people who take heartburn drugs such as Nexium, Prilosec, Prevacid

and Protonix for long periods have a significantly increased risk of hip

fractures, possibly because the drugs block calcium absorption,

Pennsylvania researchers reported Wednesday.

The drugs, which block production of acid in the stomach, are among the

most widely used in the United States, with combined annual sales of

more than $10 billion.

" The perception is that the drugs are completely safe, and doctors

dispense them without thinking too much about the risks and the

benefits, " said Dr. Yu-Xiao Yang of the University of Pennsylvania

School of Medicine, who led the study published in the Journal of the

American Medical Association.

Now, he 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.

An estimated 300,000 Americans over the age of 65 suffer hip fractures

each year, according to the National Institutes of Health, and recovery

is difficult. About 20 percent die of complications and another 20

percent are permanently consigned to nursing homes after their injuries.

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 Buchman, who was not involved in the study. " The average North

American doesn't get enough calcium anyway. "

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 , a spokeswoman 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.

Yang and his colleagues used a large British database to identify 13,566

hip-fracture patients over the age of 50 and a matched group of 135,386

healthy people.

They found that one year of using the drugs increased risk of hip

fractures by 44 percent. Long-term users who received high doses of the

drugs had as much as 2.6 times the normal risk. Men using the drugs had

about twice the risk of hip fractures as did women, perhaps because the

women were more likely to be consuming calcium supplements as

post-menopausal therapy.

Patients taking a different class of acid inhibitors that includes

Tagamet, Zantac, Pepcid and Axid had a 21 percent increased risk of

fractures after one year.

The results are similar to those obtained in a smaller Danish study

reported earlier this year, Yang said. In that study, the risk did not

increase with prolonged use or higher doses of the drugs.

Yang, who has received funding from several manufacturers, pointed out

that adequate levels of acid are required in the duodenum to dissolve

calcium salts so that they can be absorbed by the body. Studies in

animals have suggested that the acid blockers can interfere with this

process, producing a calcium deficiency that, in turn, leads to a

thinning of bones.

What's needed now, Buchman said, is a study that looks directly at

bone-mineral density to determine if it decreases in patients receiving

the drugs.

The study was funded by the National Institutes of Health and the

American Gastroenterological Association/GlaxoKline Institute for

Digestive Health.

Copyright 2006 Los Angeles Times

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