67 year old male with severe Osteoporosis from long term use of Nexium.

[Bones4Me]

I am a 67 year old male, who used to be very active. My Gastroenterologist had me on Nexium for 20 years, as my body produces a lot of stomach acid. Three years ago, my vertebrae started to break. Bone Density Scan showed me with severe osteoporosis. I just had my ninth vertebrae fracture. With these fractures, the nerves being pinched can be so painful. Over these three years I have lost three inches of height. After my initial fractures, I found out that men over 50 should not be on Nexium long term, as it robs your spine of calcium, causing osteoporosis. My life has changed drastically. I just wonder if anyone else has had a situation similar to mine. Thanks for reading.

[dcdream]

My mother, 91, has been on such meds like that (variety of them on market) and has lost 5 inches of height and has a terrible hump. She also developed severe osteoporosis as well. It has drastically changed her life. She dropped the height starting around 87.

[99real]

Sorry to hear of your side effects from Nexium. I was on a proton pump inhibitor (generic of Prilosec) for four years, until discovering I had chronic kidney disease and severe osteoporosis (in the negative 3 range) from the medication. Fortunately I have not suffered any fractures yet despite falling three times after my diagnosis. I feel fairly confident in forgoing OP drugs for now. You are in a much worse situation, so all I can do is extend my sympathies and wish that you can find a specialist for OP to guide you. Do your research on the OP drugs before deciding to take one if you go that route. Sounds like you are a good candidate for an anabolic drug, which builds back bone v. slowing down the bone breakdown process. But as you know, all drugs may have side effects and with OP drugs once you start, you may have to continue taking them in one form or another for the rest of your life. The order of drug is important too. If you need an anabolic, go straight to that instead of starting with a bisphosonate (if you were on Nexium you shouldn't take that class of drug anyway) or Prolia, because research indicates that using those drugs first lessens the effectiveness of anabolics. Good luck!

[Bones4Me in reply to 99real]

99 Real----Thank you very much for your detailed response. I am envious of you, in that you haven't suffered any fractures to date, and I hope that your good luck in this category continues, as the fractures can be painful, especially when they pinch a nerve. Your input regarding osteoporosis drugs (finding a specialist and the drugs themselves) is useful and spot on. Thanks again.

[FrogLeg in reply to 99real]

From what I have read, oral bisphosphonates can cause GERD irritation but injectable forms help avoid the issue. It also depends on the individual. Definitely agree about anabolic use prior to anti-resorptive therapy. But one must be clear that post-anabolic therapy, the patient will immediately need anti-resorptive therapy (e.g. bisphosphonates) to sustain the bone gains.

[Southerngirl2787]

I took Nexium, way back the first year it came out, for two weeks. My doctor told me it was never to be used longer than that time frame. Turned out I was Celiac. I'm so sorry your doctor failed you and caused you more pain. I had a parathyroid adenoma, for years, 3 doctors missed it for years! Finally ran my own labs and self referred to get it removed. But I truly understand the pain of fractures, I have 8 of them in the last 6 months, 7 months now. It is the worst pain ever, that includes very long labors in childbirth. I am researching everything I can to get the inflammation down, nerves calmed, and to heal. I'm not healing at all, even after 3 kyphos. I refuse all the OP meds, with the exception of Tymlos. I'm on my 3rd pen, hoping it will stop the fractures!

[Bones4Me in reply to Southerngirl2787]

Southerngirl2787-----Thanks for the input concerning your own personal story of your life in dealing with fractures. Yes, the pain and discomfort are sometimes off the charts. I try not to think about the future too much, as I don't have a warm & fuzzy feeling that I will ever get back to anywhere near physical state prior to OP entering my life. Thanks again for your input and response. Best of luck to you.

[FrogLeg]

I am a 52 year old male and have been taking PPIs since about age 26. I take a rather high dose now (30mg lansoprazole and 40mg omeprazole daily). I was recently diagnosed with severe osteoporosis (T-Scores in lumbar near -4). The best (in terms of bone growth and being well understood) treatment option for severe osteoporosis it seems is the anabolic teriparatide. I have just started it and I am tolerating it well. The drug is injectable and is typically given for 2 years. An anti-resorptive bisphosphonate is then given to keep the bone that has been restored, which would otherwise diminish. Fracture rates are the key endpoint for treatment evaluation, and they drop significantly in those treated. We also observe increased bone mineral/mass density and improved bone architecture (all of which act to decrease fractures). Incidentally, given that you have experienced fracture pain, teriparatide can be prescribed to help with the pain itself. So that is a welcome side effect/note.

I am working now to reduce or eliminate PPI usage. It is a slow, dose-titrating approach. I use concurrent H2 blockers (Pepcid) and gradually reduce the PPI meds over weeks/months. I also take Sucralfate before meals. Alternatives to PPIs with equal acid reduction properties (stronger than H2 blockers) should hopefully be available in the USA by year’s end (2023), although they may have their own risks. I would say PPIs are generally safe for those without other options, but for long term use one should be occasionally screened with a DEXA, etc, to check for early signs of issues such as bone loss. In addition to seeing an endocrinologist for the osteoporosis, if you struggle with dropping PPIs, I would suggest seeing a university-affiliated gastroenterologist to get a sense of the full range of options available. There are a range of surgeries which may help. But first try going off the PPIs using a gradual reduction and amelioration approach as I outline above.

[Bones4Me in reply to FrogLeg]

Frog Leg, Thank you for your great overview above. Sorry that you are in the grasps of Osteoporosis, especially at 52 years of age. But, it sounds like you have a clear understanding of what you need to do going forward. I am glad that the injectable drug you are now on offers no side effects, as that is a big bonus. I think I share before that I have had nine fractures to date. They are no picnic, that is for sure. I had my 6th Prolia injection(over three years) just before this last fracture. So, I have to wait the six month period before I can switch to anything else. I am going to give Evenity injections a try. Also, it sounds like you are adjusting acid reducers to see what works best. For me, after getting off Nexium (which personally I feel caused this ordeal for me), I am now on Famotidine (Pepcid AC). It doesn't handle my acid production as well as Nexium did, but I have adjusted my diet and times that I eat, to assist in getting my situation settled down. I hope the injections you are on offer great benefit for you. Regards, Bones4Me