Long-term study on medicines for heartburn
Publication Date:11/08/2008
Medicines called proton pump inhibitors (PPIs), which are commonly used for heartburn and peptic ulcers, have been linked by researchers to a slightly higher risk of fractures. But the risk only increases after several years.
If you're worried about the possible side effects of medication, don't just stop taking it. It's best to discuss your concerns with your doctor before making a decision.
What do we know already?
PPIs are a common treatment for people who get frequent heartburn (called gastro-oesophageal reflux disease) or who have peptic ulcers. You need a prescription for most PPIs, but one called omeprazole is available over-the-counter.
PPIs work by reducing the amount of acid that your stomach makes. This means there's less acid to cause heartburn or irritate an ulcer. But by reducing this acid, PPIs may make it more difficult for your body to get calcium from foods. And too little calcium can cause a condition called osteoporosis, where your bones are thinner and more likely to break.
Two previous large studies have found that using PPIs for one year or longer slightly increases the risk of a broken hip and other bone fractures. Now researchers have focused on what happens when people take these medications for up to seven years.
What does the new study say?
Researchers looked at the health records of more than 63,000 men and women aged 50 and older from a government database in Manitoba, Canada. Over eight years, nearly 16,000 had been treated for a broken bone related to osteoporosis.
Like the previous studies, the new study found that people who had used PPIs for a long time were slightly more likely to have broken a bone. But unlike the previous research, the new study found that people had a higher overall risk of a fracture only after taking these drugs for at least seven years, rather than just one year. When researchers looked specifically at the risk of a broken hip, they found that people had a slightly higher risk after taking PPIs for five years, and the risk got higher after seven years.
Where does the study come from?
The study was done by researchers from the University of Manitoba. It was published in CMAJ, which is a medical journal produced by the Canadian Medical Association. It was funded by a grant from the Canadian Institutes of Health Research.
How reliable are the findings?
This was a large study and it was well done. But this type of study (called a cohort study) can't prove that taking PPIs for a long time can lead to broken bones. It can show only that there may be a link. And researchers can't be entirely certain about this link. Perhaps there was something else about people taking PPIs that made their bones weaker and more likely to break. The researchers did a good job of taking into account other illnesses and prescription drugs that might have weakened people's bones, but they could have missed something. Also, they didn't have information on any over-the-counter treatments people were using. Notably, they didn't know whether people were taking calcium or vitamin D supplements, which can strengthen bones.
Finally, the researchers can't be sure that they knew about all the people who had broken bones. Fractures in the spine, for example, can happen without causing noticeable symptoms.
What does this mean for me?
Hearing that a drug you take regularly may cause serious side effects can be alarming. But there's no need to panic. Researchers say any bone changes related to PPIs appear to happen slowly. The question is how slowly: does the risk of fractures increase after one year, seven years, or somewhere in between? Unfortunately, we don't yet know the answer.
Although the study found only a small increase in risk, this may still be worrying if you are older or already at risk of fractures for other reasons. But bear in mind that we still don't know for sure that using PPIs for a long time can affect your bones. More studies need to look into this issue.
What should I do now?
Until we know more about the link between PPIs and broken bones, there's nothing you need to do. Still, if you're worried about possible fractures, you and your doctor might want to consider these findings when you weigh up the benefits and possible risks of using PPIs for a long time. Some people may be able to take PPIs for a shorter amount of time or use a lower dose.
If you are free from symptoms for long periods, you may be able to take this medicine only when you feel you need it. Doctors call this intermittent treatment. You may also wish to discuss with your doctor alternative treatments for heartburn such as H2 blockers.
From:
Targownik LE, Lix LM, Metge CJ, et al. Use of proton pump inhibitors and risk of osteoporosis-related fractures. CMAJ. 2008; 179: 319-326.
To learn more, see our information on heartburn and H.pylori infection (which can cause ulcers).
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© BMJ Publishing Group Limited ("BMJ Group") 2007. All rights reserved
This information does not replace medical advice. If you are concerned you might have a medical problem please ask your Boots pharmacy team in your local Boots store, or see your doctor.
