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Acid-reducing drugs increase risk of fractures, bacterial infections

The health benefits of proton pump inhibitors may not be worth the risk for some patients, according to studies in the Archives of Internal Medicine. Study authors encourage doctors to prescribe different medications for patients with minor gastrointestinal disorders or urge them to make lifestyle changes, such as not eating spicy foods. For patients with more serious gastrointestinal conditions, including esophagitis, they suggest prescribing the lowest effective dose of PPIs and reevaluating patients regularly. Several studies in the May 10 Archives of Internal Medicine examined the health effects of PPIs. These drugs "are an important medicine for certain indications like bleeding ulcers. ... But it's not worth the risk to take it for indigestion," said Mitchell Katz, MD, director of the San Francisco Dept. of Public Health, who wrote an editorial on the health risks of PPIs. Dr. Katz said 113.4 million prescriptions for PPIs are filled each year, and "for most patients, the adverse effects of PPIs outweigh the benefits" (archinte.ama-assn.org/cgi/content/extract/170/9/747/). But an increased risk of bone fractures was seen in postmenopausal women who take PPIs, according to one of the studies (archinte.ama-assn.org/cgi/content/abstract/170/9/765/). Researchers analyzed data on 130,487 postmenopausal women ages 50 to 79 who enrolled in the Women's Health Initiative Observational Study and Clinical Trials between October 1993 and December 1998. Among the women, 2.1% took a PPI medication. More than 6% took H2-receptor antagonists. After an average eight years follow-up, women on PPIs had a 47% increased risk for spine fractures compared with patients not taking the drugs. Patients on PPIs also had a 26% greater risk for forearm or wrist fractures. There was no association between PPI use and increased hip fracture risk. Risks of infection A separate study in the same Archives issue found that as the level of acid suppression in patients increases, the risk of developing nosocomial Clostridium difficile infection also rises (archinte.ama-assn.org/cgi/content/abstract/170/9/784/). Researchers examined data on 101,796 patients discharged from the Beth Israel Deaconess Medical Center in Boston from Jan. 1, 2004, to Jan. 31, 2008. Patients who took a daily PPI had an estimated 74% increased risk of developing the infection compared with people who did not take the medication. The risk of C. diff more than doubled for patients who took PPIs more than once a day. Taking PPIs also increases the risk that C. difficile will reoccur, according to a study of 1,166 patients treated for the infection in the VA New England Healthcare system between Oct. 1, 2003, and Sept. 30, 2008. Researchers found that patients on PPIs had a 42% increased risk of recurrent C. diff infection (archinte.ama-assn.org/cgi/content/abstract/170/9/772/). Unnecessary PPI prescriptions may be reduced by implementing standardized guidelines on when to prescribe the drugs, according to a separate study in the May 10 Archives. Researchers drafted guidelines for PPI use at Massachusetts General Hospital in Boston. They found that the number of inpatients receiving PPI prescriptions decreased from 27% before the guidelines were implemented to 16% after they were started. PPIs issued at discharge also dropped from 16% to 10% (archinte.ama-assn.org/cgi/content/abstract/170/9/779/). The full and original article can be found here: http://www.ama-assn.org/amednews/2010/05/24/prsc0525.htm
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