May 11, 2010 in Nation/World

Heartburn remedies carry risks

Fractures, infections increase, study finds
Thomas H. Maugh Ii Los Angeles Times
 
Tags:health

LOS ANGELES – The widely used family of acid-reducing drugs that includes Prilosec, Nexium and Protonix increases the risk of bone fractures by about 25 percent and can more than double the risk of contracting the troublesome bacterium Clostridium difficile, new studies released Monday confirm.

The increased risk is not thought to be caused by the drugs themselves, but by the sharply reduced levels of acid in the stomach and intestinal tract, which make the organs a more hospitable environment for infectious agents like C. difficile and which can impair the uptake of the calcium required for strong bones.

The drugs have also been shown to increase the risk of pneumonia.

The risks are relatively small, but the drugs are so widely used that large numbers of people are affected by them, wrote Dr. Mitchell H. Katz of the San Francisco Department of Public Health in an editorial accompanying the reports, which were published in the Archives of Internal Medicine. Katz noted that 113.4 million prescriptions for the drugs, known as proton pump inhibitors, are written each year and large numbers are sold without prescriptions.

Although the drugs have many valuable uses, he added, “for most patients, the adverse effects of (proton pump inhibitors) outweigh the benefits.”

The family of drugs, which also includes Losec, Zegerid, Prevacid and omeprazole, is widely used to treat conditions in which excess stomach acid causes pain and bleeding, including ulcers; and gastroesophageal reflux disease, in which stomach acid is regurgitated into the esophagus. But the drugs are also widely used to treat simple heartburn, and that is the condition for which they are most widely overused, experts said.

“Harm will result if these commonly used medications are prescribed for conditions for which there is no benefit, such as non-ulcer dyspepsia (heartburn),” wrote Dr. Deborah Grady and Dr. Rita F. Redberg of the University of California, San Francisco in another editorial.

Among the findings of the reports:

•Pharmacologist Shelly L. Gray of the University of Washington and her colleagues studied 130,487 women in the Women’s Health Initiative. After an average of eight years of follow-up, they found a 47 percent increase in spinal fractures and a 26 percent increase in forearm and wrist fractures but no increase in hip fractures. Overall, the increased risk of fractures was 25 percent.

•Dr. Michael D. Howell of Beth Israel Deaconess Hospital in Boston and his colleagues studied more than 100,000 patients discharged from hospitals over a five-year period. They found that incidence of infection with C. difficile increased with increasing doses of proton pump inhibitors. The hard-to-treat bacterium causes severe diarrhea and other medical problems and can be deadly if improperly treated. About 0.3 percent of those who received no proton pump inhibitors during their stay contracted C. difficile infections, whereas about 1.4 percent of those taking the most powerful drugs at least twice a day contracted the bacterium, a 136 percent increase.

•Dr. Amy Linsky of the Boston Medical Center and her colleagues studied 1,166 patients being treated for C. difficile infections. They found that 25.2 percent of those who were taking proton pump inhibitors suffered a recurrence of their infection, compared to 18.5 percent of those who were not taking the drugs, a 42 percent increase in risk.

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