New Study Links PPI Use to Hip Fractures
Over the holidays, I barely watched the news or read a newspaper. However, one story got my full attention. The press reported on a recently published medical journal article that showed a possible link between the long term use of Proton Pump Inhibitors or PPIs and calcium absorption, leading to an increased incidence of hip fractures in adults. You might be more familiar with the brand names of the PPIs such as Nexium, Prevacid and Prilosec. Since many children routinely take PPI medications to treat Gastroesophageal Reflux, I knew this was an important study. I did receive a few emails from concerned parents about the study and I expect more to come in the next few days as everyone emerges from the holiday haze.
First, Do NOT Panic! Remember that this is just one study and it is likely that more research is needed to confirm the link between PPIs and the risk of fractures. It is unclear if children will react to PPIs in the same way. Further, remember that elderly adults as a group are more prone to hip fractures due to age and other risk factors. Overall, PPIs have a long track record of use with minimal side effects in children and adults.
Do NOT abruptly stop the medication if your child is already on a PPI. As with any medication, consult with your doctor before increasing, decreasing or stopping a prescribed medication. Some children may experience a rebound effect from stopping a PPI medication suddenly and have acid hyper-secretion (an increase in acid production) and other withdrawal symptoms.
Talk to your doctor. Ask the doctor about the benefit vs. the risks of using PPIs for your child. Sometimes the consequences of not treating or under treating Gastroesophageal Reflux can lead to complications. If we didn’t have a wide range of treatment options such as PPIs, it is possible more children would develop esophageal injury and require surgery.
The new research is a wonderful opportunity to review your child’s treatment plan with the doctor.
Some questions to ask the doctor might include:
- Is this the best medication for my child?
- Can the dose be reduced?
- Does my child still need medication?
- When should we evaluate the treatment plan again?
After a period of time, some doctors will take a child off reflux medication for a few weeks to monitor treatment. If the symptoms return while the child is off medication, it may indicate that the medication is still needed. If the symptoms do not return, the doctor may suggest stopping the medication altogether. This is often called a “medication holiday” and it is an easy way to evaluate the progress of the treatment plan and make any changes.
My own theory is totally unscientific and based on only two subjects: my own refluxers! My theory is that most children do not take in the minimum daily requirements of calcium on a regular basis during childhood. Many kids drink juice boxes and soda rather than milk. Fast food and after school snacks often lack a good source of calcium. My two refluxers needed PPIs for many years and they both were diagnosed with lactose intolerance, the inability to digest a digestive enzyme in milk and dairy products. It has been a struggle since the toddler years to find calcium rich foods and supplements that they can tolerate. Since reflux is common and lactose intolerance is common, it is likely that many children are calcium deficient during the most important years for calcium intake. When they are adults, my refluxers MAY be at increased risk for hip fractures. But the big question is: will it be from poor intake of calcium rich food during childhood due to lactose intolerance or the long term use of PPIs or from some other reason altogether.
Research studies are one way to discover theories and develop new treatments. There is still a great need to study pediatric Gastroesophageal Reflux. I hope this study will lead to more research to confirm the results and to look at potential calcium absorption issues in children as well. Meanwhile, I am grateful that my kids were able to benefit from the PPIs when they needed them the most and are growing and digesting just fine.