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Heartburn Drugs Linked to Hip Fractures

Use of powerful antacids called proton pump inhibitors puts people over 50 at increased risk of hip fracture, according to a recent study in the Journal of the American Medical Association. Researchers found that taking these drugs for over a year increased risk of hip fracture by 44%. Risk of fracture increased with higher doses, and longer periods of time taking the drugs.

Proton pump inhibitors are commonly used to treat gastroesophageal reflux disease (GERD) and include drugs such as Aciphex, Nexium, Prevacid, Prilosec and Protonix.

Doctor Yu-Xiao Yang of the University of Pennsylvania, one of the offers of the study, thinks they may be too commonly prescribed:
"The general perception is they are relatively harmless. Doctors dispense them without thinking too much about the risks and the benefits. They often are used without a clear or justified indication for the treatment."
The researchers speculate that when taken consistently for over a year, these drugs can make it more difficult for the body to absorb calcium, leading to weaker bones.

An estimated 300,000 Americans over age 65 suffer from hip fractures, one quarter of which will not survive more than a year due to the injury or complications arising from it. Of those that do survive, most experience major reduction in their ability to engage in activities of daily living (ADL), such as walking and dressing, and 15% to 25% will end up in a long-term care facilities at the end of one year.

Major drug companies are already issuing responses to this study. Dr. Doug Levine of AstraZeneca PLC, which makes Nexium and Prilosec, said the study does not prove that proton pump inhibitors cause hip fractures - it merely suggests a potential association. He continued by suggesting that doctors should monitor their patients closely for correct dosage, as well as how long they're on the drugs.

With the global market for these drugs measured in many billions of dollars per year, the infighting between researchers and drug companies is likely to continue. Nexium is the third biggest-selling drug in the world, with global sales in excess of $5.7 billion last year.

Many in the medical community are advocating a more research. "This is a new observation," said Dr. Lawrence Brandt, chief of the Division of Gastroenterology at Montefiore Medical Center, in New York City. "It's exciting on the one hand, and alarming on the other hand. People should be aware that there are some data that show that there may be a higher risk of fracture."

Brandt is not concerned with the safety of over-the-counter versions of these drugs such as Tagamet and Zantac. "Most people who take drugs over-the-counter don't take them in a rigorous fashion," he said. "They take them when they need them, and their dose regimen is not going to be sufficiently compulsive and regimented that this is going to be a problem."
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