Revealing Side Effects: Acid Reducing Meds and Fracture Risk

Understanding Acid-Suppressing Medications and Their Link to Osteoporosis Risk

With the rising number of people taking acid-suppressing medications, it is hard not to wonder what side effects these drugs may have that many people do not know of. 

Before we dive into some side effects, let’s first understand what an acid-suppressing medication is. The two classes of them are: 

• Proton pump inhibitors (PPIs) - these stop acid production by slowing down proton pumps located in the canalicular membrane of the parietal cell, which are responsible for stomach acid production
• Histamine-2 receptor antagonists (H2RAs) - these target histamines, one of the primary regulators of acid suppression. 

Researchers have thoroughly investigated whether acid-suppressing medications can be linked to an increased risk of fractures, also known as osteoporosis. Osteoporosis causes bones to become weak and breakable. Bones can become so delicate that a fall or small things like bending over or coughing can cause a fracture. For most people, osteoporosis-related fractures happen in the hip, wrist, or spine. 

Osteoporosis can affect many people's lives in a very significant way. It is estimated that the mortality rate (or incidence of death) during the first year after a hip fracture is 20%. Among those people who survive this period, 1 in 5 will require nursing home care. 

So, what does the research say about acid-suppressing medications and osteoporosis?

A 2006 study in JAMA found that PPI use, especially larger doses, was related to an increased fracture risk. They also found that people who used PPIs for extended periods (greater than one year) had a higher risk of hip fracture. 

Another study completed in Denmark found an 18% increase in any fractures and a 45% increase in hip fractures for men and women who had used PPIs in the past year. 

Is one better than the other in producing less fracture risks and osteoporosis?

Well, one meta-analysis found that both PPI and H2RA use was associated with an increased risk of hip fracture. Additionally, PPI but not H2RA use was related to an increased risk of any fracture and spine fracture. They discovered that the risk of wrist fracture was not significantly observed in cases of exposure to both PPIs and H2RAs. However, it's important to exercise caution when interpreting these findings since they are derived from just three studies and thus limited by their small sample size.

You may be wondering why acid-suppressing medications may increase a person's risk of osteoporosis, so let’s talk about it. 

Researchers believe that the connection between the two is due to calcium malabsorption.

Your body requires stomach acid to digest certain forms of calcium. If we take medications to decrease stomach acid content, our body will not likely absorb all of the calcium as it should. For more information on calcium and calcium supplements, check out this article! 

Are there any preventive measures to help reduce a person's risk of osteoporosis on long-term acid suppression therapy?  

It is important that providers know about the potential association between acid-suppressing medications and osteoporosis risk. Providers should consider the lowest effective dose when prescribing medications, if possible. Individuals at higher risk of osteoporosis should discuss DXA tests (also known as a DEXA scan) with their provider. DXA stands for dual-energy x-ray absorptiometry and is a quick and painless test. 

Here are some additional factors to incorporate into your daily routine to reduce your risk of osteoporosis: 

• Increase your intake of calcium. Food sources of calcium include dairy products, dark leafy green vegetables, fortified orange juice, and sardines.
• Get enough vitamin D. Besides the sun, you can get vitamin D from fatty fish like salmon, egg yolks, and liver. 
• Exercise, especially weight-bearing exercises. 
• Drink alcohol in moderation.
• Avoid smoking and secondhand smoke. 

If you want to work on your GERD symptoms by diet and lifestyle changes, here is an article with some great tips to get you started.

1. _{Yang, Y. X., Lewis, J. D., Epstein, S., & Metz, D. C. (2006). Long-term proton pump inhibitor therapy and risk of hip fracture. JAMA, 296(24), 2947–2953.}
2. _{Vestergaard, P., Rejnmark, L., & Mosekilde, L. (2006). Proton pump inhibitors, histamine H2 receptor antagonists, and other antacid medications and the risk of fracture. Calcified tissue international, 79(2), 76–83.}
3. _{Cai, D., Feng, W., & Jiang, Q. (2015). Acid-suppressive medications and risk of fracture: an updated meta-analysis. International journal of clinical and experimental medicine, 8(6), 8893–8904.}
4. _{U.S. Department of Health and Human Services. (2023, August 4). Osteoporosis. National Institute of Arthritis and Musculoskeletal and Skin Diseases.}