PPI's and Osteoporosis

[PMRnewbie2017]

Here I go again!

To respond to some of your comments on this statement, I think it's better to create a new post, then all can see and the thread doesn't get lost.

It is true that absolute definitive research is lacking but there is evidence that use of PPI's for more than seven years is associated with an increased risk of osteoporosis related fractures. The mechanism is not clear but it is thought that gastric hydrochloric acid is important for absorption of calcium .Other papers say that absorption of iron, Vit B12 and magnesium are also compromised because of the reduced stomach acidity. It is commonly accepted that iron is absorbed in the ferrous Fe2+ form rather than ferric Fe3+, hence the advice to take iron with fruit juice or vit C. Also, PPI's do not only affect the parietal stomach cells which produce the HCl acid. Proton pumps exist in all cells including osteoclasts and osteoblasts.

The manufacturer's data sheet and patient information leaflet also states that "taking a PPI for longer than one year may slightly increase your risk of fracture in hip, wrist or spine".

So taking all into account and especially since the drug company is saying the same thing, I feel it is reasonable to avoid PPI's if also taking steroids. Why compound the risk of bone loss?

references

Use of proton pump inhibitors and risk of osteoporosis-related fractures

Laura E. Targownik, MD MSHS, Lisa M. Lix, PhD, Colleen J. Metge, PhD, Heather J. Prior, MSc, Stella Leung, MSc, and William D. Leslie, MD

Proton pump inhibitors and osteoporosis.

Andersen BN1, Johansen PB, Abrahamsen B.

Long-term proton pump inhibitor use does not increase hip fracture risk among Alzheimer's patients:

March 13, 2018

University of Eastern Finland

The Dangers of Proton Pump Inhibitors

on JUNE 14, 2016 by CHRIS KRESSER

[peace_lover]

I’m inclined to agree, especially as there are alternatives to PPI’s. It’s something as have discovered recently, to my cost. Because I have PBC I have been happily taking Omoperazole since 2004. I tolerated it well and it did the job. I hadn’t given that particular side effects a second thought as I wasn’t aware of it and no medical person picked it up.

The recently received results of a Dexa scan showed I have osteoporosis in one hip and thigh and lower spine. This scan was done months before I started on Predisolone, so can’t be attributed the steroids.

My doctor said I may have developed it anyway, and there may be a genetic predisposition as my Mother, I believe, had it, although she never had a fracture. I’m inclined to think Omoperazole played a major part in my osteoporosis, especially as I have been dancing for many years and always had an active life. Perhaps if I been given a calcium supplement things would have been different? I have taken one, pre PMR, not regularly or consistently.

I now take Rantadine, which for my part is not effective as a PPI, but there seem to be fewer long term side effects.

Lesson to be learned: re-read the leaflet that comes with your medication frequently and pay attention!

[HeronNS in reply to peace_lover]

When I looked up omeprazole I learned that it is not intended for longterm use, which means many doctors are prescribing it incorrectly.

[peace_lover in reply to HeronNS]

Yes and in my case no one, including me, picked it up. I also think the information leaflet that comes with it has changed over the years, but I was on it so long I no longer looked! It’s excellent for short term use, but it needs to be flagged up more.

[HeronNS in reply to peace_lover]

It is disturbing that as more information becomes known about drugs that the new findings aren't more generally known. For example we picked up the information about Prolia (denosumab) from the news media, yet there are still doctors who seem blissfully unaware of the serious side effect of rebound osteoporosis when it's discontinued, and still prescribe it to patients as their first, not final, option.

[Daisychain12 in reply to HeronNS]

Heron darling pls can you tell me what is the prolia info? I thought it was the miracle answer to any osteoporosis probs. Is there new contrary info? Thank you xxxx

[PMRpro Ambassador in reply to Daisychain12]

It has an excellent effect in building bone - but on stopping it patients are experiencing rebound loss of bone density and suffering vertebral fractures as a result. So when you stop it - you will probably have to take bisphosphonates anyway.

[HeronNS in reply to Daisychain12]

Denosumab (brand name Prolia) has a very good record for improving bone density fairly quickly. Because of that people would often stop taking it after two or three years. Only to discover that upon discontinuing it there was something called "rebound" osteoporosis as the bone remodelling cells recovered and started working overtime to remove bone, undoing all the good which had occurred while they were stopped from working while the drug was being taken. This rebound osteoporosis is considered a direct result of discontinuing the medication, nothing to do with the original osteoporosis. So a drug which solves the problem also can cause it. So now if people want to stop taking Prolia they have to switch to another drug and take that at least until the after effects of the denosumab have gone. Otherwise people are now being told they must stay on Prolia for at least ten years, and I suppose we really don't know yet what happens then. You can google this problem and find research papers, as well as the New York Times article which alerted many of us.

[Sandy1947 in reply to HeronNS]

I have severe osteoporosis and had every drug possible, shots in my belly for 2 yeats, Reclast and Prolio which gave increase of 10% bone health. Went back to Reclast this past year because Prolio wasn’t approved by FDC for use with steroids. In June it became approved and my Dr. has me scheduled for it in October. Shortly after first shot I was diagnosed with PMR. Of course I look to possible connections but I realize there are none.

Can you please supply understandable research that indicates negative side effects? My Rheumatlogist wants me off steroids because they weaken my already weak bones. I ignore her pressure. I have had stress fractures in both feet and now the orthopedist thinks it’s inflammation. I’m afraid of steroid shot.

[PMRpro Ambassador in reply to Sandy1947]

Negative side effects of what?

[Sandy1947 in reply to PMRpro]

Prolio side effects. I see you enumerated in post above. I’ll study what you said when I have time.

[PMRpro Ambassador]

Thank you.

I've been saying this for 9 years! They happily hand out PPIs but have a fit about the likelihood of pred-induced osteoporosis! I have read documentation for PPIs that say very clearly they should not be used for more than a few weeks at a time -so WHY do GPs hand them out like sweeties?

[Daisychain12 in reply to PMRpro]

I heard nexium is not good for long periods. I use tazac. Old fashioned but seems safer but WHO KNOWS.

[York54]

Not a comforting thought when I have been on it for 10 years!!😳😳😳😳

[jannie21 in reply to York54]

Me too just over 10 years for gastric reflux (apparently).

[yogabonnie]

I had terrible reflux until I switched my diet. Totally. no alcohol. (alas..although perhaps on a holiday!) no sugar no white flour .. (I know, ugh) lots of greens smoothies and veggies. and no reflux. No fun but definitely worth it and now have lost 13 of the 15 lbs gained on prednisone which IS fun!