Researchers are advocating caution in prescribing Proton Pump Inhibitors (PPIs) one of the world’s most commonly used drug groups. A new link with a seriously increased risk of bone fractures in older women has been found by a group of scientists from the University of Queensland. The research team examined a cohort of patients who used PPIs to treat several gastrointestinal conditions such as heartburn, gastroesophageal reflux disorder (GERD) and peptic ulcers. These drugs are commonly sold as over the counter (OTC) prescriptions in many countries and are often wrongly used for many more years than they’re really required. Patients keep taking them long after their condition is healed, so any new dangerous side effect is especially concerning. PPIs are very effective drugs that can suppress the gastric acid production by 99 percent and are often used in association with other medications to protect the stomach from their side effects. Although other antacids such as the H2 antagonists are still available on the market, PPIs are usually preferred due to their superior potency and supposed lack of adverse reactions.
Data included in the study was taken from 4432 Australian subjects cross-referenced with fracture statistics from hospitals and clinics, and with medication information coming from a national pharmaceutical administrative database. Professor Susan Tett from the School of Pharmacy explained that the results are even more alarming for the Australian elder women. The use of PPIs in female patients aged 77 and over was already linked with an increased risk of bone fractures. However, the new study provided new evidence that confirmed how esomeprazole is a dangerous drug. Both this drug (sold in the United States as Nexium), as well as the newer rabeprazole, are linked with an increased utilization of osteoporosis drug and a higher risk of fractures. Dr. Tett also explained that the widespread prescription approach to PPIs may have seriously negative consequences since these drugs are among the most prescribed medications worldwide, and advocated for a more careful approach.
Since osteoporotic fractures are associated with a high mortality and morbidity, the overprescription of antacid drugs may have an even larger impact on population health. The large number of stomach cancer lawsuits filed in the subsequent years suggest that the full range of risks associated with these medications is, at best, underestimated. The health-related prices could increase accordingly, as Professor Tett said, since PPIs treatment is often prolonged without taking in consideration other alternatives, nor verifying its appropriateness in the long-term. She proposed a treatment-on-demand approach, as well as more frequent step-down therapies. Additional investigation may provide further confirmation on whether the study’s outcome can also be applied to male patients and subjects of other age groups.
- The effect of dose and type of proton pump inhibitor use on risk of fractures and osteoporosis treatment in older Australian women: A prospective cohort study. van der Hoorn, Mariëlle M.C. et al. Bone , Volume 81 , 675 – 682
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