My husband spent a small fortune on antacids for his heartburn until he started taking a proton pump inhibitor (PPI) called omeprazole a few years ago. Now, his heartburn is in check and he even occasionally indulges in the spicy curries he loves so much.
For many people with frequent heartburn (called gastro-esophageal reflux disease, or GERD for short), PPIs are something of a wonder drug. Many people take them for years to control their symptoms, with few (if any) noticeable side effects. But now research is showing that long-term use of these drugs, although great for your heartburn, may not be so great for your bones. Studies don't agree, however, on how long you can take these drugs before your bones might be affected.
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 (PPIs are also used for peptic ulcers). But by reducing this acid, PPIs may make it more difficult for your body to get calcium from foods. Too little calcium can cause osteoporosis, a condition in which your bones are thinner and more likely to break.
Three large studies have looked into a possible connection between PPIs and fractures due to osteoporosis, using health records drawn from government databases in Canada and Europe. The first and second studies found that people who used PPIs for at least one year had a slightly higher chance of a broken hip and other bone fractures. The newest study, however, found a slightly higher risk only after people took these drugs for at least seven years. The timeframe was a little shorter when researchers looked just at broken hips. For this injury, people had a higher risk after five or more years.
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? We don't know yet. And although the studies show a link between these drugs and a higher risk of fracture, they do not prove beyond doubt that PPIs affect the bones. More research is needed to know for sure.
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 are older or at risk of fractures for other reasons, you and your doctor might want to consider these findings when you weigh the benefits and 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. And if you are free from symptoms for long periods, you may be able to take this medicine only when you feel you need it.
—Sophie Ramsey, patient editor, BMJ Group
ConsumerReportsHealth.org has partnered with The BMJ Group to monitor the latest medical research and assess the evidence to help you decide which news you should use
Find out what questions you should ask your doctor (free) if you have GERD, learn how to save money on PPIs (free), and read our full Treatment Ratings on the condition. (subscribers only).
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