We have all seen the commercials for the ‘purple pill’, otherwise known as Nexium (esomeprazole). Esomeprazole is just one of the potent drugs for peptic ulcer disease (PUD) and gastroesophogeal reflux disease (GERD) known as proton pump inhibitors (PPIs). This group of drugs was heavily marketed to the public on TV through direct-to-consumer advertising by drug companies in the last several years. The campaign seemed to work. People with heart burn everywhere were calling up their doctor asking for the ‘purple pill’.

Other examples of PPIs include Prevacid (lansoprazole), Protonix (pantoprazole), AcipHex (rabeprazole), and Prilosec (omeprazole).

Now, recent evidence suggests that taking PPIs for longer than a year can put you at a higher risk for hip fractures. It also suggests that the higher the dose, the higher the risk. Researchers are not sure why this is. It is thought that perhaps by decreasing the amount of acid in the stomach, these drugs impair the absorption of calcium.

More research is still needed though. Skeptics say that this research was done in elderly patients who already have decreased acid secretion and that the same results were not shown in younger patients with normal acid secretion. The calcium intake of the patients in these studies is also under question.

I wouldn’t stop taking your PPI just yet. The data is still preliminary and if there is a risk, it appears to be small. Data shows that you would have to treat over 1200 elderly patients with a PPI for more than a year to see an additional hip fracture in the group. Despite this, it is still a good idea to use PPIs only as directed. Prilosec (omeprazole) is a PPI that is available over-the-counter. As a result, people are turning to self treatment of heartburn symptoms. Patients who do this need to keep in mind that they need to use this medication only as directed. They should also remember that chronic use of a PPI can be a sign of a much more serious condition. If you find you are needing to take a PPI more than directed, it is best to see your physician.

It is also important to make sure you get enough calcium, whether or not you are on a PPI. Your calcium requirements depend on your sex and age. For more information on your calcium requirements, see our article ‘Osteoporosis; Bone Up on Your Knowledge’. Lastly, remember that you can help keep bones strong by staying active and taking part in weight-bearing exercises such as walking or running.

Author: Christi Larson, Pharm. D.

Dr. Larson is a Clinical Infusion Pharmacist, author of Empowered Medicine; A Guide for Consumers and creator of www.empoweredmedicine.com. You can read more about her by visiting www.EmpoweredMedicine.com and clicking on the 'About Us' tab.  EmpoweredMedicine.com is committed to providing evidence-based medical information.