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Are Powerful Antacids Linked to Higher Risk of Hip Fracture?

A recent study suggests that those who take proton pump inhibitors and are 50 or older may face higher risk of hip fracture

Some people taking powerful antacid drugs called proton pump inhibitors face an increased risk of hip fracture, according to a report published in the Journal of the American Medical Association.

Proton pump inhibitors – common brands include Aciphex®, Nexium®, Prevacid®, Prilosec® and Protonix® – are often prescribed for stomach conditions, such as gastroesophageal reflux disease (GERD).

According to the report, if you take acid-suppression medications on a chronic basis and are 50 or older, your hip fracture risk is even higher than usual. Jefferson gastroenterologist Anthony J. DiMarino Jr., MD, and orthopedic surgeon Peter F. Sharkey, MD, of the Rothman Institute at Jefferson, help put the study into perspective – and explain why this finding alone shouldn’t lead patients to discontinue use of these medications.

Anthony J DiMarino Jr., MD

Peter F Sharkey, MD

Risk greatest with higher doses, longer use
In the study, the research team from the University of Pennsylvania collected data on 13,556 people with hip fractures and 135,386 healthy people, all aged 50 or older. These people were listed in the General Practice Research Database from 1987 to 2003. This database contains information on 1.8 million patients in the United Kingdom.

Researchers found that taking a proton pump inhibitor for more than one year increased the risk of hip fracture by 44 percent, compared with people not taking these medications.

In addition, the risk was 2.6 times higher among people who took high doses over a long period. The risk of hip fracture increased with both the dosage and the duration of proton pump inhibitor therapy, the team found.

Dr. DiMarino and Dr. Sharkey say it’s not surprising that this study has attracted a lot of attention due to the widespread use of proton pump inhibitors and the often-devastating consequences of hip fracture. Indeed, elderly persons who suffer a hip fracture have a death rate of 20 percent during the first year after the fracture. For those who survive this period, one in five requires nursing home care, an emergency department visit, hospitalization, surgery, and rehabilitation – all with huge healthcare costs.

“There’s no question that everyone wants to avoid hip fracture,” Dr. Sharkey explains. “However, before anyone stops taking a proton pump inhibitor, it’s very important to understand more about the patients who were studied.”

Specifically, he notes that the patients in this study had several other risk factors for hip fracture. Among them: smoking, alcohol use and dementia.

“What’s more, many of those studied were physically smaller, which is a risk factor for osteoporosis and fracture,” Dr. Sharkey says.

In other words, use of proton pump inhibitors probably wasn’t the only factor that contributed to higher risk of hip fracture among the study population.

The case for proton pump inhibitors
The researchers speculate that proton pump inhibitors hinder calcium absorption in some people. Stomach acid is needed to help the body absorb calcium, and proton pump inhibitors work by slowing the production of stomach acid.

And, some clinicians assert that proton pump inhibitors – which have been on the market for 15 years and have been considered safe for chronic use – are prescribed too often.

But both doctors are quick to note that people take proton pump inhibitors for a reason. As Dr. DiMarino explains, the potential consequences of stopping the medication are severe.

“When you don’t take proton pump inhibitors, GERD can lead to more serious conditions, such as Barrett’s esophagus, which is linked to esophageal cancer,” he explains, adding that a type of adenocarcinoma (cancer involving cells from the lining of the walls of various organs) of the esophagus is the second-fastest rising cancer in the United States.

So, should clinical practice change based on this study? Dr. DiMarino and Dr. Sharkey say no.

“This is the first large-scale study of its kind. Patients need to understand that the findings have not yet been confirmed by a subsequent study,” Dr. DiMarino explains. “If you’re taking acid-suppression therapy and are concerned, please consult with your physician.”

Preventing osteoporosis
Dr. Sharkey says the study’s key takeaway for everyone – including people of all ages who take proton pump inhibitors, as well as those who are not taking these medications – is to do everything possible to prevent osteoporosis.

Dr. Sharkey suggests the following measures to help reduce the risk of osteoporosis:

Make exercise part of your routine. “You don’t have to jog or jump,” he says. “Even walking or riding a bicycle – really, any kind of physical activity – helps keep bones strong.”

Eat a diet rich in calcium and vitamin D. Dr. Sharkey adds that people should also take supplements. “For adults – and women, in particular – the Food and Drug Administration currently recommends 400 units, or milligrams, of vitamin D per day, but that recommendation is about to change to 1,000 units per day,” he says, adding that women should also take 2,500 milligrams of calcium every day.

Avoid smoking. “There’s a strong link between smoking and weakening bones,” Dr. Sharkey says. “If you smoke, quitting is an important way to help reduce your risk of osteoporosis.”

Always consult a physician before making any major lifestyle changes, including taking supplements or beginning an exercise program.

To schedule an appointment with a Jefferson physician, call 1-800-JEFF-NOW. Regardless of your needs, including location, types of insurance accepted, and particular expertise, JEFF NOW® will help you find the doctor that’s right for you and get you an appointment quickly and easily.