For decades, Gastroesophogeal Reflux Disease (GERD) has been treated rather easily and efficiently without any controversy or sophistication. Patients were encouraged to first try lifestyle changes. After a couple of lame attempts at cutting out spices and reducing things like chocolate and alcohol, doctors would quickly call it quits on non-drug treatments and wind up prescribing acid-reducing drugs such as Prilosec, Prontonix, Nexium, and Aciphex. Together, these drugs, commonly known as PPIs (Proton Pump Inhibitors), quickly formed the cornerstone of reflux treatment, carving out a $25 billion per year portion of healthcare dollars. To the delight of doctors and patients, PPIs seemed to be capable of wiping out reflux symptoms with virtually no apparent side effects or drug interactions.
The safety of long-term PPI use started to come into question about one year ago. Researchers began to raise questions about possible risks that long-term users may develop, particularly with regards to osteoporosis. By suppressing acid build-up, the mechanism by which PPIs are thought to control reflux, patients may wind up absorbing much less calcium from their food. With less calcium absorbed, patients might have less available minerals for building high quality bone. So down the road, the concern is that patients who take PPIs may have a higher risk for hip fractures.
Before even thinking about stopping your PPI, you need to consider several issues. Firstly, if your risk for osteoporosis is low to begin with, then the chances of developing future bone problems on account of PPI use will likely remain low, period. So no need to change a thing. On the other hand, if you already have osteoporosis or are considered to be at high risk, then it might make sense to minimize PPI use by trying other alternatives. For example, the previous generation of acid controlling medications, such as Zantac or Pepcid may perform just as well in controlling reflux symptoms. What’s more, no evidence has implicated Zantac to future osteoporosis or hip fractures. The catch here is that Zantac, for a considerable number of people, is generally not as effective as PPIs.
Secondly, you ought to make a legitimate, wholehearted attempt at anti-GERD lifestyle measures. These measures include sleeping with the head of the bed at 45 degrees, losing weight, and avoiding consumption of alcohol, chocolate, and spicy foods. Yes, we doctors are all about eliminating all forms of fun.
If all of the above fails and PPIs turn out to be the only method to achieve effective control of GERD symptoms, then so be it. If you continue taking PPIs then you simply need to do your best to prevent and/or treat osteoporosis, i.e, making the most of excercise and consuming adequate amounts of calcium and Vitamin D.
In the end, the issue of PPIs and osteoporosis is relatively minor. Unlike other more immediate health related concerns, the question of PPIs and its relationship to osteoporosis can be dealt with calmly and in the context of an office visit. So please don’t toss your Nexium pills out into the garbage quite yet.
