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Q.

How concerned should I be about medicine for gastroesophageal reflux disease resulting in bone loss and broken bones?

 

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A.

Several studies have shown a connection between certain acid suppression medicines and an increased chance of breaking a hip. The medicines in this study are in a class of drugs called proton pump inhibitors (PPI). They include Nexium®, Prevacid® and Prilosec®. PPI medicines are used very commonly to treat conditions such as heartburn and acid reflux disease.

The link between the PPI medicines and the risk of a broken hip appears to be a problem only for people on fairly high doses, equal to 40 mg or more a day, for a long period of time. People who use over-the-counter or even prescription doses once in a while should not be concerned.

Talk to your doctor first before stopping your medicine. Many people take these medicines for serious medical conditions. These medicines are important for people with major health problems, but they are not for everyone. Patients should be prescribed the lowest effective dose available to treat their condition(s). People concerned about taking these medicines should speak with their doctor or other healthcare provider about whether they need to continue using the medicines.

Ask your healthcare provider if you need a bone mineral density test. Long-term use of the PPI medicines may increase your chance of getting osteoporosis and having broken bones. If you are on high doses of these medicines for a long time, speak with your healthcare provider about whether you should have a bone density test.

Your calcium needs. To keep their bones healthy, adults need to have a balanced diet. This includes eating a variety of fruits, vegetables and calcium-rich foods. It is especially important for people taking PPI medicines to get at least 1,200 mg of calcium every day. While some people on these medicines may need a bit more calcium, they should not get more than 1,500 mg a day.

If you don’t get enough calcium from food, you need to take calcium supplements to get the rest of the calcium that you need. If you are taking PPI medicines, you may want to take calcium citrate supplements rather than other calcium supplements. Because these medicines block stomach acid, your body may absorb calcium citrate better than other types of calcium supplements. Unlike other calcium supplements, calcium citrate does not need stomach acid to be absorbed.

If you take another type of calcium supplement, like calcium carbonate, be sure to take it with a meal or snack. Your body makes stomach acid when you eat. Most calcium supplements need stomach acid to dissolve and for calcium to be absorbed.

Bone healthy behaviors. Like calcium, vitamin D is also important for your bone health. It helps your body absorb calcium. People under age 50 need between 400 and 800 international units (IU) of vitamin D every day. People age 50 and older need between 800 and 1,000 IU of vitamin D every day. Some people may need even more. Getting regular weight-bearing and muscle-strengthening exercise helps keep your bones strong and healthy. Drinking too much alcohol and smoking is harmful to your bones.

Abstract of the PPI Study

You may view the abstract of the study reported in JAMA by visiting this Web page: http://jama.ama-assn.org/cgi/content/abstract/296/24/2947.

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