Surprising Link Between Acid Suppressants and Your Bones

Regular readers have heard from me before about the dangers associated with long-term use of drugs that suppress stomach acid, specifically the powerful proton pump inhibitors (PPIs) including esomeprazole (Nexium), omeprazole (Prilosex) and lansoprazole (Prevacid). So it's no surprise to us that here comes yet another study adding to the alarm about the use of PPIs. This latest research shows an increased risk for hip fractures among older patients using PPIs, and that the risk is especially high for those using higher doses or for those using PPIs for longer periods -- or, most especially, both. This latest study takes the risk of PPIs to a whole new level, never before discussed here.

The study, from the University of Pennsylvania, reviewed 13,556 hip fractures and 135,386 controls from the United Kingdom General Practice Research Database, a collection of electronic medical records taken from 1987 to 2003. All of the data were from people older than age 50 at enrollment; some used PPIs and others were non-users but matched for sex, age and other factors. The mean age at enrollment in the database was 77, and 79% were female. Researchers found that people who had used a PPI for more than a year had an associated increased fracture risk of 44%... long-term use of higher doses was even more startling, with 2.6 times elevated risk compared with non-users. Because 20% of the cases of hip fractures lead to death within a year, and older adults are increasingly being prescribed PPIs, these findings are especially scary.

what's the connection

I called Daily Health News consulting medical editor Andrew L. Rubman, ND, who has been extremely vocal about the dangers of acid-suppressing treatments to find out what is behind this problem and what steps people on PPIs can take to help avoid a future fracture. He noted that PPIs are effective medicine for people who have evidence of an ulcer. But protracted use of a PPI, for more than four weeks, is always risky, he says, to say nothing of the dangers to those in the study who had used the medication for a year or more. In truth, says Dr. Rubman, many people take a PPI not because of ulcers but to treat gastritis, an inflammation of the stomach lining that causes pain, belching, bloating and nausea. But, says Dr. Rubman, many of them are also hoping the PPI will protect them from developing the much worse GERD (which, in fact, only rarely happens). "I would argue," says Dr. Rubman, "that most often GERD is not present as a significant health risk and is used as a fear goad to steer the patients and physicians into the prescription."

Thus, taken to quiet the stomach, when used for more than three weeks, the drugs can end up significantly disabling the body's natural ability to produce digestive acids, says Dr. Rubman. This not only creates havoc in the digestive process, but also intrudes on the body's ability to absorb calcium and magnesium. Both of these minerals are essential for strong bones, but must be transformed in the stomach first in order to be absorbed and used in the body. This process requires a strong acidic environment, not one that has been suppressed. Without adequate levels of stomach acid, calcium and magnesium won't be absorbed properly, no matter how much you ingest.

Given the enormous popularity of PPIs, it's evident that there are many people who have compromised their stomach acid, and who may be in danger of fracture. One problem, notes Dr. Rubman, is that it's likely that many older adults who have been long-term users of PPIs will have become hypochlorhydric -- meaning that they can no longer make enough hydrochloric acid to properly digest a meal. The solution, says Dr. Rubman, is to work with a naturopathic physician or other medical professional highly trained in enzyme use to begin rebuilding the body's ability to produce enzymes on its own... that will then trigger the natural production of stomach acid. Indeed, he adds, this is a necessity for anyone who has taken PPIs for longer than three weeks. It's quite possible that many people will have to take enzyme supplements with meals for the rest of their lives... but, Dr. Rubman says that even in people who have healthy stomachs, regular digestive enzyme use can be beneficial, so, in general, no worries there.

Be well, Carole Jackson - Bottom Line's Daily Health News

Source(s): Andrew L. Rubman, ND, consulting medical editor, Daily Health News, and director, Southbury Clinic for Traditional Medicines, Southbury, Connecticut