Ulcer Pills and Fractures

People on either Proton pump inhibitors(PPIs) or histamine-2 receptor blockers (H2RAs) have a 1.3 – 1.7 times risk of hip fracture. This risk disappears after stopping the medication for 3-5 years. With PPIs causing bacterial overgrowth, and with it stomach and possible mood issues, these drugs are looking less and less enticing..

Proton Pump Inhibitors and Histamine-2 Receptor Antagonists are Associated with Hip Fractures among At-Risk Patients
Douglas A. Corley, Ai Kubo, Wei Zhao, Charles Quesenberry
Gastroenterology 2010 in press abstract here

Am J Gastroenterol. 2009 Mar;104 Suppl 2:S21-6.
Proton pump inhibitors and bone fractures? a review
Laine L. abstract here

  • Multiple studies have all demonstrated an increase in fractures ranging from 1.2-1.92 times risk while on PPIs.
  • PPIs means Omeprazole (Losec), Lansoprazole (Prevacid), Pantaprazole (Pantaloc, Tecta), and Nexium.
  • The histamine-2 receptor blockers (H2RAs) were not immune but had slightly lower rates (1.18-1.23 times). This means famotidine (pepcid), ranitidine (zantac), and cimetidine (Tagamet).
  • There is even a dose-response effect by number years:
    (note- two different studies)
  • At one point, there was a concern fall rate increases might explain this effect
  • Most importantly, most recent article found “this association was only found among persons with at least one other risk factor for hip fracture.” This includes:
    Make worse – inactivity, no calcium intake, no vitamin D supplementation, low estrogens or testosterone, corticosteroid use,
    make better – thiazide diuretic use, biphosphonate use

Theories include:

  • Diminished bone density by decreasing calcium absorption.
  • Inducing hyperparathyroidism through hypergastrinemia.
  • Modifying acid-related enzymes in bones that regulate bone remodeling.

What can you do?

  1. Don’t panic – under a 2 times increase is not that bad. It takes over 1 year to show any effect at all.
  2. Take you reasons for needing an ulcer pill seriously – if it’s for acid reflux – lose weight and yes, you really don’t need that coffee…
  3. Consider taking the ulcer pill every second day (Consult your doctor about that). There was a dose- response effect:
    (After 4 – 6 years use)
  4. Get your calcium but in liquid form – without acid, you might not be able to fizz up otherwise insoluble calcium tablets – take a soluble (often calcium citrate) form. One needs 1-1.5 gms/day.
  5. Go on a biphosponate (bone building pill). If you can’t tolerate it, consider the once/year infusion. Zometa (Zoledronic Acid) 4mg IV though about $400.00 and not covered.
  6. Go on hormones – estrogens under 60 are good for you. Over 60 consider Evista as it helps with pains as well – but is not cheap and may not be covered by plans:
    New Painkiller for Back & Knee Pains – Raloxifene (Evista) – a drug for Osteoporosis
    If you have breast cancer- take Tamoxifen which works better.
    Have your testosterone levels checked (yes, women too). Poor sleep lowers it and so I find they are often low in chronic pain.
    If you are on thyroid, make sure you are not taking to much.
  7. If you are on blood pressure meds, consider having it changed to a thiazide water pill -they prevent calcium urine lose.
  8. Vitamin D 1000-4000u/day
  9. Get your bone density checked.
  10. Exercise!!

Comment – Why can’t they make pills that have side effects that make you smart or something? Well, I guess Zoledronic Acid (Zometa) IV may prevent cancer metastatic disease but one study testing this was cancelled due to lack of funding…
ZOMETA® (Zoledronic Acid) for Prevention of Bone Metastases

They were going to give IV four times/year rather than once yearly…

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