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Sometimes drugs that people have long taken for granted become less appropriate-possibly even dangerous-as patients grow older. Popular drugs used to treat heartburn probably should be considered in this category, although they are not usually listed as drugs that are too risky for older people.
Does Nexium Weaken Bones?
Q. My wife and I are in our 70s. She has been taking Nexium for years. We recently read that this kind of medication could increase her risk for bone fracture. How could this be true?
A. Acid-suppressing drugs such as esomeprazole (Nexium), lansoprazole (Prevacid) and omeprazole (Prilosec) interfere with the absorption of minerals such as calcium and magnesium. A recent article in the Journal of the American Geriatrics Society (Nov. 2015) suggests that taking such proton pump inhibitors (PPIs) for more than two months could be too risky for older people. It can lead to C. diff intestinal infections as well as bone loss and fractures. The most recent meta-analysis confirms that regular use of PPIs can increase the risk of both hip and spine fracture (International Journal of Clinical and Experimental Medicine, June, 2015).
Older People Are Not the Only Ones at Risk:
Withdrawal Symptoms:
There is a fair amount of evidence that everyone who takes a PPI for more than two months might experience some undesirable side effects. One that has been highly debated by gastroenterologists is the likelihood of rebound reflux (Gastroenterology, July, 2009). Volunteers with no history of reflux symptoms suffered heartburn or indigestion for several weeks when they stopped taking Nexium suddenly after being on it for two months.
Changes in Gut Bacteria:
There has been increased scientific attention to the importance of the balance of bacteria living in our digestive tracts. A recent experiment indicates that disruptions in the ecology of the microbiome can faciliate infection with Clostridium difficile, a type of bacteria that can cause a nasty, hard-to-treat diarrhea (Gastroenterology, Oct., 2015).
We are sending you our Guide to Digestive Disorders with a discussion of the pros and cons of these medications and the alternatives. It also has information on tactics to get off a PPI.
christine
I was prescribed nexium daily for two decades. During normal activity (stepping down a ladder), I skipped last step. When my foot reached the floor I heard loud crack& hit floor in agony. I’d fractured middle finger, crushed my tibia, patella, & damaged the meniscus. Needed internal fixation & was in wheel chair walker, then cane for three yrs. I blame nexus. At 55 I had first dexa scan, and they found I’ve got osteoporosis. Damage is done & now, with this blown up opiate crisis, I’m forced to suffer in bed unable to function due to chronic pain. Where’s the justice in America?
David
Florida
So if this medicine changes the gut bacteria, would it not be beneficial for a doctor to advise taking probiotics too? And should they not warn us of side effects if taken over a long period of time?
Not everyone, particularly the elderly, can do research online, and pharmacists seem so busy at times and we aren’t even aware we should question the medicine…..trusting in our doctors.
Jim
Wisconsin
A friend of mine was on acid blockers, more and more as she got older. She has changed her diet to eat protein and starches separately about 2 hours apart. You can google and find specifics. She no longer needs ANY acid blockers — even Tums. It’s the first I’ve heard of it but she swears by it. As I understand it protein and starches’ digestion times are very different, and they get in the way of one another.
Will Salazar
Albuquerque, NM
I want to tell my story about Anti-acids. My Dr. started me on Anti-acids when I was in the Air Force. He started me on Tetralac 2 pills per day. In later years different Drs. changed my prescription to Prevacid, Prilosec and eventually to Nexium. I took these Meds for nearly 50 years. I also took Tums, Alka-Seltzer and numerous other anti-acids when my Prescriptions were not handy.
At age 45 I developed Lactose Intolerance. I had several bouts of Diverticulitis. I had to get a Colonoscopy every year, and every time I had one, My Colon looked worst than the year before. 6 years ago, I came to the conclusion that all my problems were caused by all those Anti-acids that I had been taking for so many years.
I started slowing down on taking these pills in Dec. of 2008 and on Jan 1st of 2009, I quit anti-acids completely. I started drinking a double shot glass full of Apple Cider Vinegar in the morning and eating a half of an apple in the afternoon and 1/2 apple at bedtime. It was tough for the first 2 years. But, I don’t suffer from Acid Reflux anymore. After 4 years I went to a small amount of Vinegar and I still eat my apple at bedtime.
During these 6 years, I have not had a single bout of Diverticulitis and I no longer have Lactose Intolerance. My colon has improved so dramatically that my Dr. cannot believe its the same colon that he has been seeing for years. As of now, I will not have to have another Colonoscopy, ever. Other people my have different symptoms from prolonged use of Anti-acids.
Rosanna
Georgia
I have just recently asked my doctor to take me off PPIs. I was having extreme stomach cramps, diarrhea, heart palpitations, and dizziness. I have been on all the PPIs and they all caused problems for the last 15 years. My doctor now has me on Famotidine, which is generic for Pepcid.
What a difference. My dizziness has stopped, my stomach problems have stopped, my palpitations are stopped, and I noticed something I wasn’t expecting — my finger nails have stopped splitting and chipping. My nails are now stronger and longer than they have been in years. If these PPI’s were doing this to my nails, you could just imagine what they were doing to my bones. I am so disappointed in the medical profession.
David
Florida
I am an 80 year old male – heart attacks, stents, AAA, blocked carotid and other health problems, I have been on Lansazaprole 40 mg for many months (years) in order that all my medications do not cause stomach upset.
I take iron and Bisoprolol later in the day as it could prevent absorption or interfere with same (which I was not told about but did my own research), and I also take probiotics (at my own volition) in the hope that I am replacing the good flora that this medicine may hurt.
I also take Atoravastatin 40 mg. (for many years was on Simvastatin), and my cardiologist still believes I need this. My cholesterol is now very low.
I do not get the side effects of muscle cramps etc., (fortunately), but worry if I should listen to reports or my doctor!
R
I am one of those that this applied to. Was told by my GI doc in 2003 that I must take PPI’s for my reflux to “decrease” my risk for esophageal cancer. I had some inflammation but no Barrett’s esophagus. Did all the lifestyle changes, head of bed elevation, avoiding trigger foods, 4 hours empty stomach before bedtime, etc. Yet despite all this my endoscopies still showed inflammation and I had symptoms (mainly sore throat as my reflux went all the way up). The drugs never worked all that well.
At the time they were prescribing PPI’s like candy and saying these drugs were perfectly safe. Nonetheless over the years they caused me B12 and Iron and Vit D deficiency (for which I had to take supplements to treat) and even one of them caused my normal blood sugar to go into the pre-diabetes range so I was switched from one to another to another and the blood sugar normalized. Finally I paid for the 24 hour expensive monitoring to see exactly what was refluxing. Turned out that the total number of refluxes in 24 hours was normal but what was abnormal and causing damage was that half of them were base not acid. And also half went up to the larynx. So no wonder the PPi’s didn’t work as these drugs only help with acid reflux.
At that point I stopped the drug, read Dr. Jamie Koufman’s book Dropping Acid and started a low acid diet. Over 3 years later my symptoms are more improved than they ever were on the drugs. Before the 9 years of PPI use my bone density was normal. After this use I am just over into the osteoporosis range for the spine and have osteopenia in the hips. I am sure the PPI’s were a factor and that without them I would be mildly osteopenic because I have most my life done weight bearing exercise, weight circuit work and followed a healthy diet. Now they have black box warnings on these PPI’s.
Bottom line is that any drug you take will have side effects and the proven (and I mean proven) benefits of the drugs must outweigh the risks before you decide to take any drug. For this reason I am not touching the osteoporosis drugs which for many people cause not only reflux (and the need for those bone robbing PPI’s), pathologic fractures and actually make your bones more brittle. There is more to fracture risk than density. A bone can be dense but very brittle and dried out and unfortunately that is what many of these drugs do. So they are not for me. Never. So changing my supplement use to add chelated magnesium, got a weighted vest to wear for 60 min while walking 5 days a week, saw a physical therapist to get exercises which target the bones in my spine and my hips and also have increased my weight machine circuit to 3 times a week and this time gradually increasing the weights I do and continuing with aerobic exercise.
Ann
West Virginia
I have been taking either Nexium or Omeprazole for probably 6 – 7 years – maybe longer. I have scoliosis with two bad curves and lots of arthritis. I was prescribed diclofenac for ulcers that occurred due to the drug. The gastroenterologist told me that as long as I am on diclofenac that I would have to take a ppi to prevent the ulcers.
The diclofenac is doing a wonderful job of keeping my joint moving. If I discontinue diclofenac for as little as a week, which I had to do prior to cataract surgery a few years ago, I get to the point that I can barely get around.
Recently I had a fall that caused a good deal of discomfort and I ended up going to a medical express to make sure nothing was broken, and while they could not find any new injuries, they found that I had 2 compression fractures of the L4 & L5 vertebrae and they looked to be about a year old, based on the amount of healing to the bones.
I’m in a terrible catch 22 situation and my doctor and I are pondering how to proceed. They are trying to set up an MRI, but they are having trouble trying to find out if I can take one as I had a complete knee replacement 6 or 7 years ago and the doctor who did the replacement has left the area and the hospital seems to not have the records as to the type of knee was used.
I’m not sure just what my outcome will be. I have dropped from taking 2 pills a day to 1 and after a few days of discomfort, I seem to be doing fine on the lower dose, but I’d love to get off of it entirely.
To make matters even more fuzzy is the fact that my blood work is showing signs of a possible tendency towards diabetes – possibly set off by the drug, Lipitor (or it’s generic version). So much for our wonderful (?) wonder drugs.
alxzba
In my late 60s, when Nexium first hit the gastrointestinal market, my GI doc prescribed it for my reflux. I tried it.
What happened had to be a classic negative reaction to the drug: diarrhea, oily stools and anal leakage. I reported these reactions to the doctor, who then recommended doubling the dosage. I changed doctors and have not taken Nexium since. As I recall, confirmed in Peoples Pharmacy above, the enclosed information with Nexium recommends only a relatively short duration of usage.
Now, to put the drug OTC seems to me to verging on unethical practice of medicine, backed by and with the encouragement of $$$s greedy Big Pharm. To give the general public, who probably does not read the negative possibilities of the med, open access to such a drug seems to me to be unethical. And don’t expect the public, especially older individuals, to read very small print interspersed with technical chemistry explanations.
Judy
Maryland
This not about withdrawal but your mention of heartburn medicines brings up a warning. My husband’s life was almost ruined by omeprazole (Prilosec). A few years ago, when he was 70, he developed a horrible rash all over his body, plus muscle weakness and difficulty thinking. A dermatologist had no idea what the rash was, and a neurologist couldn’t figure out what his mental difficulty was.
It was a report here on the People’s Pharmacy that started us connecting the dots. It was about a rare side effect of omeprazole — a rash that resembled one from an auto-immune disease, found in a small study in Italy. My husband stopped taking omeprazole and the rash gradually disappeared, along with the mental problems, and the muscle weakness much more slowly. I’ve never heard of the rash side effect anywhere else, and the other two symptoms nowhere at all, but I’m quite convinced about the first two because they started clearing up immediately when he stopped taking the drug. The muscle weakness appeared at the same time as the other symptoms so we think it’s connected to omeprazole too.