A new study is providing more evidence of an association between hip fractures in older women and the use of popular heartburn drugs known as proton pump inhibitors (PPIs). The study, published in the British Medical Journal, found that post-menopausal women who take PPIs are 35 percent more likely to suffer a broken hip compared to women who don’t use the medications. The risk was even higher for women who took the drugs the longest, as well as those who were smokers.
PPIs are a class of prescription and over-the-counter drugs that include Nexium, Dexilant, Prilosec, Prilosec OTC, Zegerid, Zegerid OTC, Prevacid, Prevacid 24-Hr, Protonix, Aciphex, and Vimovo. They are approved to treat gastroesophageal reflux disease (GERD), sometimes referred to as acid reflux, as well as gastric ulcers, erosive esophagitis and stomach bleeding associated with using non-steroidal anti-inflammatory drugs.
PPIs have long been suspected of increasing the risk that users will suffer fractures of the hip, spine and wrist. The U.S. Food & Drug Administration (FDA) first warned of this possible PPI side effect in March 2010. That May, the agency announced it would be adding information about the potential fracture risk to the label of prescription PPIs. This came after a review of several epidemiological studies reported an increased risk of fractures of the hip, wrist, and spine with PPI use. Some studies found that those at greatest risk for these fractures received high doses of proton pump inhibitors or used them for one year or more. The majority of the studies evaluated individuals 50 years of age or older and the increased risk of fracture primarily was observed in this age group.
This latest study involved data on nearly 80,000 U.S. women between the ages of 33 and 55 enrolled in the Nurses Health Study. Every two years, they were asked how often they had taken PPIs and whether they had suffered any hip fractures. According to the study, use of PPIs increased nearly 3-fold from 2000 to 2008 among the women in the study, from 6.7% to 18.9%. The most commonly used PPI in the study was omeprazole (Prilosec and Prilosec OTC), followed by lansoprazole (Prevacid). A total of 893 hip fractures were recorded during the time period the women were followed.
The study found that for every 2,000 post-menopausal women taking the PPIs for a year, there would be more than four fractures compared with three in 2,000 women not taking them. The risk for post-menopausal women who took PPIs for at least two years was 35 percent higher. Women who took the drugs for six to eight years were 50 percent more likely to suffer a broken hip. Postmenopausal women with history of smoking who took PPIs for longer than two years had more than a 50 percent chance of sustaining a hip fracture. However, the risk of hip fracture returned to normal two years after women stopped taking proton pump inhibitors, the researchers said.
“In summary, regular use of PPI was associated with increased risk of hip fracture among post-menopausal women, with the strongest risk observed in individuals with the longest duration of use or with a history of smoking,” the research team from Massachusetts General Hospital concluded.
It’s not known for certain why PPIs might be associated with an increased risk of fractures. But it is believed that the drugs interfere with the body’s absorption of calcium, which would lead to weaker bones.