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According to a new study, heartburn drugs like Nexium and Prilosec may increase risk of osteoporosis—a disease in which the bones become weak and brittle and prone to fracture.

A study in the journal of International Journal of Rheumatic Diseases, has raised more concerns about the potentially serious side effects of these drugs. Previous studies have linked PPIs with an increased risk of chronic kidney disease, and heart disease.

Researchers Examine Daily Use of PPIs

For the study, researchers examined data from 80 patients (31 male and 49 female) aged 20-45 years old who had no history of hip fracture or other bone problems. Scientists followed the patients for at least two years. Forty of them took “PPI” drugs (like Nexium or Prilosec), while the other 40 did not use these drugs.

The researchers also evaluated x-rays to assess bone mineral density in the femur (thigh bone) and spine in all participants.

PPIs (proton pump inhibitors) are medications that can block the production of stomach acid. They work by neutralizing enzymes involved in the process of creating stomach acid. They came onto the market in the 1980s, and quickly took over the market. They are now the “go-to” treatments for conditions like gastroesophageal reflux disease (GERD), esophagitis (inflammation of the esophagus), and stomach ulcers.

Regular use of these drugs, however, is associated with increased risk of other serious health problems. Several recent studies have suggested that people are using them too often without being aware of the potential side effects.

In a February 2016 study, researchers found that participants taking PPIs had a 20-50 percent increased risk of kidney disease compared to those who had never taken the drugs. Twice-daily dosing was associated with a higher risk than once-daily dosing, and the longer the patient took the medications, the greater their risk.

A Long Trail of Evidence on PPIs and Bone Fractures

Results of the study showed a significant difference between those who regularly used PPIs and those who didn’t. Overall, the group taking these drugs had a significantly higher risk of femoral osteoporosis and osteopenia (reduced bone mass) than the control group. That means that these patients would be at a higher risk of femoral fracture than their counterparts who weren’t taking the drugs—and these were patients who had no signs of bone loss at the start of the study.

This study is only the most recent to supply evidence that these drugs may not be damaging to our bones. In May 2010, the FDA warned that PPIs could increase risk of hip, wrist, and spinal fracture. They cited several epidemiological studies that reported an increased risk of these fractures with regular PPI use. The greatest risk was in those patients who used high doses for a year or more.

In March 2011, the FDA determined that a warning on the label of these drugs concerning bone fractures was “not indicated at this time,” primarily because short-term use of the drugs were unlikely to cause bone problems. It did acknowledge that though the drugs are intended for short-term treatment, consumers may take the products for longer periods of time.

“Healthcare professionals should be aware of the risk for fracture if they are recommending use of OTC PPIs at higher doses or for longer periods of time than in the OTC PPI label,” the FDA directed.

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