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?
- Don’t panic – under a 2 times increase is not that bad. It takes over 1 year to show any effect at all.
- 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…
- Consider taking the ulcer pill every second day (Consult your doctor about that). There was a dose- response effect:
(After 4 – 6 years use)
- 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.
- 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.
- 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. - If you are on blood pressure meds, consider having it changed to a thiazide water pill -they prevent calcium urine lose.
- Vitamin D 4000u/day
- Get your bone density checked.
- 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…
Anybody got any comments or suggestions?