Men's Osteoporosis Support GroupMore on proton pump inhibitors and osteoporosis
CMAJ. 2008 Aug 12;179(4):319-26. Use of proton pump inhibitors and risk of osteoporosis-related fractures. Targownik LE and others. PMID: 18695179. This is a Canadian study regarding proton pump inhibitors (PPIs) with results similar to one by Yang Y and others covered in a recent Update. Administrative data was used for persons having fractures and compared to three times the number of controls that were matched for age, sex and comorbidities. The authors found "We did not detect a significant association between the overall risk of an osteoporotic fracture and the use of proton pump inhibitors for durations of 6 years or less. However, exposure of 7 or more years was associated with increased risk of an osteoporosis-related fracture (adjusted OR 1.92, 95% confidence interval [CI] 1.16-3.18, p = 0.011)." Additionally they found increased risk of hip fracture after five years of PPI therapy with increasing risk at seven or more years of therapy. The authors interpret these results as follows: "Use of proton pump inhibitors for 7 or more years is associated with a significantly increased risk of an osteoporosis-related fracture. There is an increased risk of hip fracture after 5 or more years exposure." Editor's comments. The Yang and others study found increased risk of fracture after only one year of PPI use, whereas no difference was found by Targownik and others until at least five years of PPI therapy. The cause of fractures might be due to the low stomach acid when PPIs are used which creates a poor environment for dissolution and absorption of calcium. As I mentioned previously there is nothing to indicate that those of us taking approved osteoporosis medications are at any risk of fracture if taking PPIs. Hopefully additional research will shed light on that topic. But the increased risk of fracture for those taking PPIs would make it ideal if one could safely stop taking them and control or eliminate acid reflux with other methods. My use of PPIs. I had been on omeprazole for acid reflux for a couple of years when I was told to increase the dose, which I didn't want to do. I did quite a bit of research and decided I didn't want to be taking this medication if I could figure out how to stop using it. Since about February 2008, I have been able to stop the omeprazole and stop the acid reflux almost completely. I make no claims for my methods that they might work for others, and anyone hoping to do the same should consult their medical provider regarding stopping the PPIs. In summary, this is what I did: 1. I bought several books with titles directed toward stopping acid reflux. These suggested methods ranging from going on the Atkins diet to checking for yeast. After reading these I concluded they would not help, but I did find some helpful information in them and in several searches on the Net. Also my reading gave me additional reason to want to stop the PPIs as I uncovered other information that wasn't too positive about them. 2. I bought a wedge-shaped pillow to sleep on at night. An online search will show several of these on the market. I bought the Med Slant pillow because it folds into a square for easy movement on trips, etc, and because the reviews on it were excellent. Others might work just as well. This helped immediately to eliminate the night-time reflux. Additionally I have found that sleeping on the left side is very important. If you view a diagram of the esophageal-stomach junction you'll see that the esophagus joins part way down the right side of the stomach. This means that sleeping on the right side would move liquid contents of the stomach toward the esophagus. Sleeping on the left side moves the contents away from the esophagus. 3. I stopped taking the omeprazole because I wanted to be able to tell if my changes were effective, opting to take antacids if needed to control reflux. I gave myself two months to stop the reflux, concluding I'd go back on omeprazole if needed at that time. I made several diet changes which eventually led me to become a vegan, wherein I eat no animal products. I also try to reduce the portion size and I don't eat spicy foods while also not eating at all for about three hours, or more, before bed. I read several books that lead me to become a vegan: The China Study, The Okinawa Program, Diet for a New America, The McDougall Plan, as well as doing a lot of online research. It took a few weeks for everything to work, but gradually I was able to stop the antacids almost totally. 4. Results. If I can eat exactly as I want to and sleep on the slanted pillow I have virtually no acid reflux. When I have any it is almost always at night just before bed if I ate a larger amount of food than I should have, ate out, or similar. I never ignore acid reflux but take 1/2 or a full antacid at the first sign. I have had one esophageal endoscopy about two months after I started my new program and the results were good with no indications of abnormal cells or increased inflammation. 5. Bottom line. This has worked for me, but I can't assure it will for others. And I'm not exactly sure what changes I made are the most important. The wedge pillow appeared to be effective immediately, so I'm a firm believer in it. Stopping spicy foods was also helpful and I've reinforced that by accidentally ordering spicy food when eating out which then required antacids. Smaller portion size also seemed to help very quickly, and that is the hardest change to adhere to on a daily basis. Whether the vegan lifestyle is critical I don't know, but I wouldn't change no matter what since I've reaped many other medical benefits from it and because of my ethical feelings regarding eating that way.
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