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That's a good question. Lately, we have received several inquiries from patients concerned about a possible increased risk of hip fractures in those on long-term acid suppressive medication like Nexium. This concern is based on a study from the University of Pennsylvania which was recently reported in the news. It referred to a class of drugs called Proton Pump Inhibitors, or PPIs, which includes Nexium, Prevacid, Protonix, Aciphex, Zegerid, and Prilosec. The report was a retrospective look at the risk of hip fractures in patients on PPIs compared to controls. It was concluded that taking such medications may decrease intestinal absoption of calcium from the diet.
The results have not been confirmed by other investigators, but are of some concern. For centuries, children drank milk as their main beverage. All during their formative years, calcium was being deposited into their bones. The baby boomers are the first generation who were raised on Diet Coke and Dr. Pepper which, of course, contain no calcium. Because of this, many scientists feel that osteoporosis will be the epidemic of the future as millions of "baby boomers" pass from middle age to Medicare age. Any factor that may decrease calcium absorption must be addressed.
Osteoporosis risk
All adults, especially women, should be aware that their personal risk of osteoporosis and hip fractures rises with age. Many factors can increase this risk such as not enough calcium in the diet, lack of regular weight-bearing exercise, menopause, being "small boned," long term use of steroid medication such as prednisone, intestinal diseases such as Crohn's disease and celiac sprue. A family history of osteoporosis is also a risk factor. Caucasians and Asians also have a higher risk. Perhaps taking acid suppressive medications will be added to the list.
No cause for alarm
However, there is no cause for alarm. This information is quite preliminary and has not been verified by other investigators. Over the past 18 years, we have used these drugs in thousand of patients and have not seen a rise in such fractures.
What should you do?
If you are currently taking a PPI drug for acid reflux or to protect you from damaging effects of arthritis medications, you should NOT stop it. There is no immediate risk. However, it is important that you consume at least 1000 mg of calcium and 400 U of Vitamin D in your daily diet. This is true of all adults - even those who are not on these medications. This is best done with the use of non-fat dairy products and simple calcium supplements. If you are taking a drug like Nexium long-term, we recommend taking two capsules daily of either Citracal + D or Os-Cal 500 + D to boost your calcium intake. Both are over-the-counter and best taken with food.
Bone density testing
Those in high risk groups should have bone density screening exams performed periodically. This is all just part of normal healthy preventative maintenance that all adults over 50 should undergo - especially those at highest risk. If you have any questions about this, discuss it with your doctor on your next routine visit. More information can be found in this article from our archives.
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