Better Health: Smart Health Commentary

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Well, I fell for it again – that panic that follows breaking news that a drug once thought to be safe was now causing some horrible, unexpected side effect.  I nervously wrung my hands as I thought of all the proton pump inhibitors I had prescribed for heartburn in the past.  Did I hurt my patients?  Are they all lying in a hospital somewhere with pins in their broken hips?

I took a deep breath and decided to go back to the source of the news. There it was – the offending research study in the Journal of the American Medical Association.   I read it carefully – looking for the devil in the details.  And lo and behold, the caveats started slinking off the pages.

First of all, the “44% increased risk of hip fractures” sounds really bad, doesn’t it?  Well, what if I said that a person’s risk of getting a hip fracture (IF they were over 55 years old AND took a proton pump inhibitor for over a year straight) was 1.44 in 1000 whereas if they never took the medicine, their risk would be 1 in 1000.  Does that sound as bad?  Well, I’m actually saying the same thing.

There were some other interesting details – men were significantly more likely to get fractures than women 1.78:1000 compared to 1.36:1000.  There was no explanation as to why that might be.  Also, I noticed that there was no discussion of a potential confounder – which of these patients were in nursing homes?  In my experience, patients in nursing homes often automatically get proton pump inhibitors – and stay on them indefinitely as “GI prophylaxis.”  Now if you’re sick enough or demented enough to be in a nursing home, then you’re probably at higher risk for falls… which would be a good reason why people on proton pump inhibitors break their hips more frequently, right?  If you fall more frequently, then – bingo – there goes your increased risk for fractures.

Well, the research does seem to suggest that there’s a trend – people who take proton pump inhibitors for long times in higher doses may have a higher risk of fractures.  But the jury’s still out on why that may be.  For most folks in the US who are under the care of a watchful physician, their dose and duration of taking the medicine doesn’t put them at increased risk at all.

So to me the take home message is that people shouldn’t stay on proton pump inhibitors indefinitely, which isn’t really news to me.  I hope that this blog entry has reduced your anxiety level… stay tuned for more critical analysis of research findings.