Heartburn medications can increase risk for hip fractures in postmenopausal women
Posted by on February 23, 2012 - 7:54am

Older, postmenopausal women who take popular medications to control indigestion and heartburn called proton pump inhibitors (PPIs)  may put themselves at higher risk for hip fractures according to new research by Dr. Hamed Khalili, from Massachusetts General Hospital in Boston.  Long-term use of these drugs may increase that risk by 35 percent and even higher (to 50 percent) in smokers.    Some examples of these medications are shown here.

According to the researchers, PPIs are strongly indicated in some patients for short term use, but they should be closely monitored if long term use is needed.  Dr. Khalili's data supports the recent decision by the U.S. Food and Drug Administration to revise labeling of PPIs to incorporate concerns about a bone fractures with use of these products.  

For the study, they looked at data from 80,000 postmenopausal women. .Over the course of eight years, almost 900 hip fractures occurred -- a 35 percent increased risk for women using PPIs compared to women who didn't take the drugs.   In absolute terms, the risk of hip fracture works out to about 2.02 fractures for every 1,000 person years for those taking PPIs, compared with 1.51 fractures per 1,000 person years. Person years are the number of years in a study multiplied by the number of people in the study.  The increased risk of fractures among women who smoked was even higher. The longer a women took a PPI, the more her risk increased.

In 2000, 6.7 percent of the women used PPIs regularly, generally for acid reflux; by 2008 that had jumped to 18.9 percent. This could mean that more fractures will be seen in years to come.   Women who stopped using PPIs saw their risk of hip fracture return to normal within two years, Khalili's group noted.   Women are also cautioned not to suddenly quit their PPI and gradual tapering is recommended to avoid acid rebound.   Often, calcium supplements are used to bolster bone strength, but because PPIs affect the absorption of calcium, taking calcium supplements may not be effective.  The researchers did take calcium supplement use into account and the risk remained.

SOURCE:  Jan. 31, 2012, BMJ, online

 

 

Heartburn: Reflux or GERD?
Posted by on May 3, 2011 - 10:11am

Most of us get heartburn from time to time. It may come as a burning sensation in the chest, or a bitter taste in the back of the throat. Heartburn is one word people use to describe reflux. It happens when stomach contents come back upwards. Reflux is sometimes painless: You may have trouble swallowing or get a dry cough, perhaps some wheezing.

Occasional reflux episodes are normal. Like millions of Americans, you can manage reflux by avoiding foods that don’t agree with you—things that are fatty, spicy or acidic—or by eating smaller meals. If reflux occurs less than once a week, you can usually cope by making lifestyle changes or using over-the-counter medications.

“We all have a little reflux when we burp or belch,” says Dr. John Pandolfino of Northwestern University. But of the 20 million or more Americans with reflux, about 5% have significant episodes 2 or 3 times per day. When severe events occur this often, it’s not ordinary reflux. It may be gastroesophageal reflux disease (GERD). You may need prescription medications to control it.

Surprisingly, there is very little data addressing sex differences in GERD--and perhaps this is one condition where sex differences only play a small role.  In the few studies that do exist, it appears that the overall incidence of heartburn, regurgitation, non-cardiac chest pain, and wheezing was the same in both sexes though there may be a higher intensity and frequency of symptoms in women but the clinical significance is not clear.   Heartburn is more prevalent during pregnancy and increases in each trimester but that  is believed to be due to anatomic changes such as the pressure of the expanding uterus or, possibility, something to do with progesterone level during pregnancy. It usually goes away after pregnancy.   Obesity and body mass index seems to increase the risk of GERD.

GERD should be taken seriously. Stomach (gastric) contents contain acid needed to digest food. In reflux, these contents wash upward into the esophagus, a slender tube connecting the mouth and the stomach. Because the lining of the esophagus isn’t meant to touch gastric acid, the acid can irritate the lining of the esophagus and lead to bleeding and scarring. In adults, GERD can raise the risk of cancer of the esophagus. And if you have asthma, GERD can make it worse.

As for babies, reflux is common in healthy infants. Most babies outgrow reflux by 13 months, but if they don’t, they too may have GERD.   GERD can harm a child’s ability to feed and grow. It can also increase the risk for inhaling stomach contents into the lungs which could be life-threatening.

People of any age can have GERD. Available medications, whether over-the-counter or prescription, can make the acid in the esophagus less intense. But medications don’t prevent GERD. Surgery can be an option if symptoms are severe and medicine and lifestyle changes don’t seem to help.  The problem isn’t that the stomach makes too much acid. In GERD, the special set of muscles between the esophagus and the stomach is weakened.  Scientists are beginning to look at how nerves receive and send messages to these muscles.

If you have reflux twice or more per week, talk to your health care provider. It’s best to start treatment early to prevent GERD from leading to more serious health problems.

How To Steer Clear of Reflux

Maintain a healthy weight.
Eat smaller meals.
Avoid triggering foods, including alcohol.
Don’t lie down for 3 hours after a meal.
Raise the head of your bed 6 to 8 inches by putting wood blocks under the bedposts.
For an infant, try burping frequently during feeding. Keep the infant upright for 30 minutes after feeding.
If you have reflux twice or more per week, see your health care provider.