Several types of prescription drugs increase bone fracture risk

Drugs and Bones

You can take prescription drugs to treat heartburn, drugs to treat depression, drugs to treat asthma, and drugs to prevent osteoporosis. But will your bones survive even one of those treatments?

Looks good on paper

Bean counters. They’re adorable!

Researchers at the University of Michigan estimated the lifetime cost of using a proton pump inhibitor (PPI – such as Nexium or Prilosec) to curb gastrointestinal bleeding caused by daily aspirin therapy (to lower heart attack risk). They concluded that the therapy was cost-effective for those who start their PPI regimen earlier in life.

Coincidentally, details of the UM study were released on the SAME DAY that another PPI study appeared in the Canadian Medical Association Journal. In that study researchers reported: “Use of proton pump inhibitors for 7 or more years is associated with a significantly increased risk of an osteoporosis-related fracture.”

You might spend the final years of your life in a wheelchair, but the good news is that your PPI use has been cost effective. Enjoy!

Putting on the hurt

The risk of fractures in patients who use PPI drugs should be no surprise to HSI members. In the e-Alert “These Hips Don’t Lie” (1/16/07), I told you about a study that linked PPI use to an increased risk of hip fracture. And in subjects who used a PPI over a long period, fracture risk increased significantly.

But PPIs aren’t the only drugs that threaten bone health.

ASTHMA INHALERS
Doctors have known for some time that taking steroids in pill form contributes to bone loss. In a 2001 study of 109 women between the ages of 18 and 45, researchers found that subjects who took frequent puffs from asthma inhalers significantly increased their rate of bone loss. Researchers recommended that asthma patients use the lowest effective dose from inhalers, engage in weight-bearing exercise, and supplement with calcium and vitamin D.

ANTIDEPRESSANTS
In a five-year trial that followed 8,000 women over the age of 65, subjects who took antidepressant drugs were found to be 70 percent more likely to suffer disabling hip fractures. Researchers suspect that reduced alertness, prompted by the drug use, may have played a role in the higher incidence of fractures.

BISPHOSPHONATES
Amazing but true – longterm use of bisphosphonates (such as Fosamax) to prevent osteoporosis may actually increase fracture risk. In the e-Alert “Sinking Fast” (4/7/08), I told you about a Cornell University study of 15 women who experienced femur fractures. Ten of the women had a similar, very specific type of fracture. Among these ten, Fosamax had been used for an average of more than seven years.

If you’re currently using any of these types of drugs, talk to your doctor about bone health concerns.

Sources:
“Long-Term Acid Reflux Therapy Can Be Cost-Effective” Reuters Health, 8/12/08, nlm.nih.gov
“Use of Proton Pump Inhibitors and Risk of Osteoporosis-Related Fractures” Canadian Medical Association Journal, Vol. 179, No. 4, 8/12/08, cmaj.ca