Women who take certain drugs for heartburn, acid reflux and peptic ulcers are raising their risk of hip fractures by as much as 50 percent, according to researchers at Harvard Medical School and Massachusetts General Hospital in Boston.
The drugs, called proton pump inhibitors (PPI’s) are used by millions around the world who suffer from chronic and painful symptoms of indigestion. They are a class of prescription and over-the-counter drugs that include Nexium, Dexilant, Prilosec, Prilosec OTC, Zegerid, Zegerid OTC, Prevacid, Prevacid 24-Hr, Protonix, Aciphex, and Vimovo. They are approved to treat gastroesophageal reflux disease (GERD), sometimes referred to as acid reflux, as well as gastric ulcers, erosive esophagitis and stomach bleeding associated with using non-steroidal anti-inflammatory drugs.
Researchers studied 80,000 women participating in the Nurses Health Study, a large ongoing study that began in 1976. Post-menopausal women who used PPI’s regularly for at least two years were 35% more likely to suffer hip fractures. The risk grew to 50% if the women were current of former smokers.
The numbers sound alarming, but the actual “risk” of a hip fracture is still relatively small. Among the women who used PPI’s, about two in every 1,000 fractured a hip each year. For non-users, the figure was about 1.5 fractures for every 1,000 women.
Researchers also found that two years after women stopped taking PPI’s, their risk of hip fracture returned to the level of women who had never taken them. Women taking H2 blockers to treat indigestion had a “modest” increase in hip fractures, but the risk was higher in women who took PPI’s.
PPI use increased dramatically in the U.S. when the Food and Drug Administration approved the drugs for over the counter sale in 2009. PPI’s inhibit the stomach’s production of gastric acids that can cause heartburn, acid reflux and peptic ulcers. The most widely used PPI’s are omeprazole and lansoprazole. Novartis sells lansoprazole under the brand name Prevacid.
Short term use of PPI’s is generally well tolerated, but concern has grown over their association with bone fractures, especially of the hip. PPI’s may inhibit calcium absorption, which is important for building strong bones.
Researchers say their findings are “compelling evidence” of a risk between PPI use and hip fractures. They say long term use of PPI’s should be carefully evaluated, particularly among women who have smoked or are still smokers.
“Although PPI use might be strongly indicated in some patients, at least for short-term use, we believe that clinicians should continue to carefully monitor the need for long-term use of these medications, specifically among postmenopausal women with a history of smoking,” said lead researcher Dr. Hamed Khalili, a clinical and research fellow in gastroenterology at Massachusetts General Hospital in Boston.
“Our data supports the recent decision by the U.S. Food and Drug Administration to revise labeling of PPIs to incorporate concerns about a possible increase in risk of fractures with these drugs,” he said.
It’s not known for certain why PPIs might be associated with an increased risk of fractures. But it is believed that the drugs interfere with the body’s absorption of calcium, which would lead to weaker bones.
The study was published online in the British Medical Journal.