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Powerful Antacid Drugs Raise Fracture Risk
Date:8/11/2008

rand names include Aciphex, Nexium, Prevacid, Prilosec and Protonix. The drugs are often taken for indefinite periods of time.

The drugs work by inhibiting secretion of hydrochloric acid; this may affect calcium absorption in the small intestine.

The mechanism by which extended use of proton pump inhibitors increases the risk of fracture is unknown; however, it is most likely due to the acid-inhibiting effects of proton pump inhibitors accelerating the rate of bone mineral loss.

The authors of this study, from University of Manitoba in Winnipeg, examined administrative claims data for 15,792 individuals over 50 who had had osteoporosis-related fractures of the hip, vertebra or wrist, then compared them with almost 50,000 controls.

Individuals who had used proton pump inhibitors for seven or more years had almost double the risk of an osteoporosis-related fracture. There was also a 62 percent increased risk of hip fracture after five or more years of using PPIs; the risk of hip fracture jumped to more than quadruple after seven or more years.

"From this newest article, the comfortable zone looks like a length of time longer than the other studies, seven years, which is a nice amount of time. That's enough time for any type of peptic ulcer disease to improve," Schnoll-Sussman said.

Other patients may have to stay on the drugs indefinitely, but some could benefit from diet and other lifestyle modifications, especially for those who have returned to old eating habits after experiencing the benefits of the drugs.

"Some people think, 'If I take PPIs, I can eat garbage all day long,' " Schnoll-Sussman said. "We need to tighten up on those patients. These medications are not without any kind of risk."

Another new study, this one in the Aug. 11/25 issue of Archives of Internal Medicine, concluded that it is cost-effective to add over-the-counter proton pump inhibitors to the regimens of
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