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Treatment Changes Since FDA Warnings

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Posted 8/30/2011 6:01 AM (GMT 0)
Have any of you who take PPIs made any changes based on the FDA warning about studies that show increased bone fractures related to high dose or long-term use of these drugs?

I take 20 mg Omeprazole daily for Laryngopharyngeal reflux.  I have all the classic symptoms for LPR if I don't take a PPI, so what I plan to do at my next physical exam is ask the physician to measure calcium and magnesium level and Vitamin B12 level, since these are poorly absorbed in the absence of stomach acid. I also think I should get a bone density DEXA scan, even though I'm male (age 62), because of the increased fracture risk. 

I take a calcium (1000 mg)/magnesium (400 mg)/Zn (30 mg) supplement at bedtime, which should help boost these and also is purported to help with relaxation and sleep.

Any thoughts? 

Posted 8/30/2011 10:31 AM (GMT 0)
I wish that FDA warning were more strongly worded: “Epidemiology studies suggest a possible increased risk of bone fractures with the use of proton pump inhibitors for one year or longer, or at high doses,” said Joyce Korvick, M.D., deputy director for safety in FDA’s Division of Gastroenterology Products. “Because these products are used by a great number of people, it’s important for the public to be aware of this possible increased risk and, when prescribing proton pump inhibitors, health care professionals should consider whether a lower dose or shorter duration of therapy would adequately treat the patient's condition.”

MY GI doc brushed it off when I brought it up. "We are just suspicious", he said. "You need to keep taking your medicine". I was on Prilosec for three months, now Nexium for two months. Next month I plan to alternate my PPI with Gaviscon. He implied I couldn't "afford" to do that, but I believe he was holding the cancer threat over my head. The threat of cancer is way less than the bone fracture, though, and I choose to lessen my risk of fractures in this manner. I already have orthopedic and neurologic problems, and making them worse WILL make my life more miserable.

Calcium is absorbed most effectively taken in two daily doses, with food. I need to check into those other supplments.
Posted 8/30/2011 2:11 PM (GMT 0)
Tim,
I am at risk of osteoporosis because my father has it and my bone scan showed osteopenia and I take oral and inhaled steriods for asthma.
I did decrease my use of PPIs in favor of H2 meds (Zantac) but my asthma is worse because of it. I suspect steriods are harder on bones than PPIs.
Thanks for the info about Magnesium and B12.
I looked up the definition of Laryngopharyngeal reflux and that is definitely what I have been experiencing for 30 years. Too bad every doctor and asthma nurse specialist has insisted it was Post Nasal Drip in the complete absence of nasal symptoms.
I'm amazed how much more help I have gotten from other people with similar problems than from specialists.
Leslie
Posted 8/30/2011 4:52 PM (GMT 0)
Tim G

i have LPR and i dont take PPIs...i have experienced and read about too many side effects

i dont want to disuade other people from taking their meds.... im a bad example

there is so much that is unkown out there and more and mor im playing hunches...gambling with my life, really

but i control, best i can, my reflux with diet, meditation, H2s when i have to go to big deal dinner, and calcium carbonate

there is some research that indicates bile is a major actor in the damage done by reflux, and to my understanding, PPIs dont control bile secretions

there is also some research out of the university of Pittsburgh (dr jobe et al) questioning whether or not PPIs might pose a small but measurable risk themselves for possibly causing neoplasm

http://www.post-gazette.com/pg/11213/1164375-114-0.stm

i just dont know what to think anymore
Posted 8/30/2011 9:01 PM (GMT 0)
I was on different PPIs for 10 years, most recently was 40 mg Nexium once a day. My Calcium has been in the normal range when I get a blood test every 6 months. I do not take calcium supplements or vitamins. I have had some acid reflux while on PPIs so there was some acid in my stomach. I had a TIF in April and stopped the Nexium a month ago.
Posted 8/30/2011 10:07 PM (GMT 0)
Tim G,

I've taken PPIs for months now.

My late mom broke her hip. I have a bone density scan every two years. I have osteopenia.

I take 1500mg calcium citrate, 1200 mg D and also take a Centrum Silver multivitamin daily as per my PCP.

My calcium, D, and B12 levels were checked two weeks ago and all is fine.

Whether on PPI's or not, older men should get the bone scan also according to my PCP.

Blessings,
Cme
Posted 8/30/2011 10:07 PM (GMT 0)
I was on PPIs for 10 years and H2 blockers for 4 years and developed stomach polyps.
The medicine is not a long term solution. It's a bandaid and it will not cure GERD or LPR.
Posted 8/31/2011 5:07 PM (GMT 0)
Thanks to everyone who responded to my post.  PPI use is a controversial issue after recent studies have shown problems.  I'm guessing that H2 drugs would cause similar problems, although the studies were conducted with PPIs, the drug of choice for most with GERD.  There's no simple answer. 

Please jump in and respond with your thoughts if you haven't already.  This has been a very interesting and thought-provoking discussion

Tim

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