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Less acid, brittler hips? Some heartburn drugs may be behind an increase in fractures
December 27, 2006
Older people who take heartburn drugs for long periods have a significantly increased risk of hip fractures, possibly because the drugs block calcium absorption.
Our Review Summary
This is a compact (only 566 words), nicely reported story that places a potentially important development in its appropriate context. The researchers went to great lengths in their published study to weed out variables other than heartburn drugs that might explain the increase in hip fractures that they observed. Nevertheless, they acknowledge that their retrospective review of a large patient database is inherently incapable of proving cause and effect. The quote from Dr. Alan Buchman in the news story summarizes this chief drawback well: The patients, he notes, may “have some other problem that increases the risk of fractures.” The study provides reasonable evidence to support the news article’s recommendations that patients should only use the drugs if they need them, and even then take them only at their lowest beneficial dose. Whether “the solution is to simply consume more calcium” remains unknown, unfortunately. Additional advice on the benefits of lifestyle and dietary changes would have been welcome, and perhaps a note on the relatively lower fracture risk associated with the class known as histamine blockers. In the end, the take home point may be that patients and doctors should periodically question the need to take any medicine used over the long term, even ones thought to be very safe.
Click on Criteria for definitions.
Most readers are likely to know about heartburn drugs or antacids that suppress the production of gastric acid. They are, as the LA Times says, “among the most widely used in the United States.” Some of these medicines are also available over-the-counter without a prescription, potentially useful information omitted from the news article.
The report notes that combined sales of these drugs account for more than $10 billion annually. The article does not mention comparative costs for other ways of managing the medical conditions these drugs treat.
There are no obvious elements of disease mongering. Hip fracture is common and often devastating. As the article suggests, it is the final insult on the slope toward death for one in five people. It dispatches another one in five to nursing homes for the rest of their lives. However, the article provides information only on relative risk of hip fractures, not their absolute risk. The very large relative risks cited may overstate the absolute risk of these medicines, even if there is a true risk of fracture.
Though the article ably employs a quote by Dr. Alan Buchman to explain the chief limitation of the study’s design—that it cannot prove cause and effect, and that the patients simply may “have some other problem that increases the risk of fractures”—the story could have stated more clearly the drawbacks inherent in a retrospective study of a large patient database.
The article provides balanced information about the frequency and seriousness of one potential harm of taking antacids—hip fractures. Most other research has turned up relatively minor side effects (e.g. gastrointestinal discomfort, diarrhea), though a 2005 study suggested that these drugs might make people more susceptible to virulent clostridium difficile infections that produce dangerous watery diarrhea.
The report states that the treatment is widely used and accurately implies that it is not new.
The news article does not quantify the potential benefits of treatment with heartburn or antacid drugs. They are very effective in preventing acid-related disease. An additional sentence or two might help readers weigh their pros and cons.
No obvious use of text from a press release.
The news article reports the funding source for the study, cites three sources—the study’s author, an academic gastroenterologist, and a spokeswoman for the manufacturer of Prevacid—and provides adequate information to judge their potential conflicts of interest.
The article explains that heartburn drugs may cause hip fractures by blocking calcium absorption. It suggests two potential solutions – either “simply to consume more calcium,” or to take the drugs in lower doses. Unfortunately, it fails to note that there is conflicting research to support the calcium-blocking hypothesis or that there is little research to show that calcium consumption can offset the increased risk of fracture among people taking antacids. More importantly, the article could have offered three additional recommendations: (1) all patients may not need to take these medicines on a regular basis; (2) lifestyle and dietary changes—cutting back on caffeine, alcohol, cigarettes, and acidic foods—can also help; and (3) some patients taking one class of drugs known as proton pump inhibitors (e.g. Nexium, Prevacid, Prisolec) could safely switch over to another class known as histamine blockers (e.g. Zantac) that were associated with fewer hip fractures in this study. Histamine blockers have a very safe long-term record (20+ years).
Total Score: 9 of 10 Satisfactory
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