Antacid Conditions

Published article: Dec. 26 (HealthDay News) — People taking powerful antacid drugs called proton pump inhibitors face an increased risk of hip fracture, University of Pennsylvania researchers report.

Common proton pump inhibitors include Aciphex, Nexium, Prevacid, Prilosec and Protonix; they are often prescribed for stomach conditions such as gastroesophageal reflux disease (GERD). The report is published in the Dec. 27 issue of the Journal of the American Medical Association.

‘If you take acid-suppression medications on a chronic basis and you are 50 or older, your hip fracture risk is even higher than usual,’ said study author Dr.Yu-Xiao Yang, an assistant professor of medicine and epidemiology.

‘In addition, if you are one of the few patients who requires high doses, then your risk is even higher,’ Yang added.

In the study, Yang’s team collected data on 13,556 people with hip fractures and 135,386 healthy people, all aged 50 or older. These people were listed in the General Practice Research Database from 1987 to 2003. This database contains information on patients in the United Kingdom.

The researchers found that taking a proton pump inhibitor for more than one year increased the risk of hip fracture by 44 percent, compared with people not taking these medications.

In addition, the risk was 2.6 times higher among people who took high doses over a long period. The risk of hip fracture increased with both the dosage and the duration of proton pump inhibitor therapy, Yang’s group found.

Yang speculated that these drugs hinder calcium absorption in some people. Stomach acid is needed to help the body absorb calcium, and proton pump inhibitors work by slowing the production of stomach acid.

Among the elderly, hip fractures have a death rate of 20 percent during the first year after the fracture. For those who survive this period, one in five requires nursing home care, an emergency department visit, hospitalization, surgery and rehabilitation, all with huge health-care costs.

Yang said he thinks these drugs are prescribed too often. ‘Not everybody is on this medicine for good reasons,’ he said. ‘Proton pump inhibitors have been on the market for 15 years, and the general feeling is that they are safe to be taken on a chronic basis. So, they are given often without having a clear indication or without making sure the patient is benefiting from the medication.’

Moreover, Yang thinks that both men and women taking prescription proton pump inhibitors should also take a calcium supplement to insure that they maintain their bone mass and lower their risk of hip fracture.

One expert thinks that people should not be overly concerned with this finding unless it is confirmed by other studies.

‘This is a new observation,’ said Dr. Lawrence Brandt, chief of the Division of Gastroenterology at Montefiore Medical Center, in New York City. ‘It’s exciting on the one hand, and alarming on the other hand. People should be aware that there are some data that show that there may be a higher risk of fracture.’

Although Brandt agreed that these drugs are prescribed too often and used by some people for too long a time, he noted the findings shouldn’t change clinical practice yet.

‘If someone doesn’t need proton pump inhibitors, they shouldn’t be on the drug,’ he said. ‘Proton pump inhibitors are probably one of the most abused classes of drugs in the world. So, there are a lot of people on this medication who shouldn’t be on this medication.’

In addition, people should only take these medications for as long as necessary to treat the condition it’s been prescribed for, Brandt said. ‘If you have to take it for a long time, then you should also have your bone density followed once a year,’ he added.

Brandt is not concerned with the safety of the over-the-counter versions of these drugs. ‘Most people who take drugs over-the-counter don’t take them in a rigorous fashion,’ he said. ‘They take them when they need them, and their dose regimen is not going to be sufficiently compulsive and regimented that this is going to be a problem.’

Source: 12/26/06

Calcium again linked to lower colorectal cancer risk…

By Stephen Daniells
1/17/2007- The potential protective effects of calcium supplements against colorectal cancer may carry on for five years after people stop taking the supplements, research has revealed.

The Calcium Follow-up Study, an observational study that followed the Calcium Polyp Prevention Study, found that people from the original calcium supplementation group had a significant 12 per cent lower risk of any adenoma five years after the original supplements were stopped, compared to people from the placebo group.

‘The protective effect of calcium supplementation on risk of colorectal adenoma recurrence extends up to five years after cessation, even in the absence of continued supplementation,’ wrote lead author Maria Grau from Dartmouth Medical School in the US.

Colorectal cancer accounts for nine per cent of new cancer cases every year worldwide. The highest incidence rates are in the developed world, while Asia and Africa have the lowest incidence rates.

It remains one of the most curable cancers if diagnosis is made early.

In the Calcium Polyp Prevention Study, 930 people with a recent adenoma were randomly assigned to receive four years of daily 1200-milligram calcium supplements or a placebo. The study revealed that those assigned to calcium supplements had a 17 per cent lower relative risk of an adenoma recurrence than those who got the placebo.

The new research, published in the Journal of the National Cancer Institute, used data on 822 of the original 930 subjects from the Calcium Polyp Prevention Study. Of these subjects, 597 underwent at least one colonoscopy exam, and completed follow-up questionnaires.

Grau and her colleagues report that, during the first five years after the end of the original study, those randomly assigned to the calcium supplementation group had a 12 per cent lower risk of all adenomas than those from the placebo group (31.5 versus 43.2 per cent).

During the next five years (five to ten years after the end of the Calcium Polyp Prevention Study), no significant difference was observed between subjects from the calcium or placebo groups, said the researchers.

‘Our study provides further evidence of the potential of calcium as a chemopreventive agent against colorectal adenomas among individuals with a history of these tumours,’ wrote the researchers. ‘Our data indicate that, in these patients, the protective effect of calcium may extend for up to 5 years after the cessation of active treatment.’

While no mechanistic study was performed in this study, the researchers did propose two mechanisms to explain the apparent beneficial benefits of calcium. The first concerned calcium’s ability to bind and precipitate bile acids in the bowel, thereby making them inert and protecting against inflammation. The second possible mechanism involved activation of the so-called calcium sensing receptor (CSR) which has been reported to have anti-cancer effects in vitro.

In an accompanying editorial, Maria Martinez and Elizabeth Jacobs from the Arizona Cancer Center in Tucson asked: ‘Where do we go from here–and, more important, what public health recommendations related to calcium do we provide for risk reduction of colorectal cancer?’

Martinez and Jacobs note that current US guidelines recommend that people simply consume recommended levels of calcium (1000 mg/day for adults up to age 50 years and 1200 mg/day for those older than 50 years). ‘Because no protection for colorectal cancer is apparent at higher levels of calcium intake, this recommendation is justified,’ they said.

‘Large clinical trials of calcium and colorectal cancer are unlikely to be launched in the near future. However, should the opportunity arise, we should consider taking into account that, as is the case for many nutrients, individuals with lower rather than higher nutrient intakes are likely to benefit the most from supplementation and that those who have already exceeded the threshold of prevention may experience no added protection,’ said Martinez and Jacobs.

Source: Journal of the National Cancer Institute
Volume 99, Pages 129-136
‘Prolonged effect of calcium supplementation on risk of colorectal adenomas in a randomized trial’
Authors: M.V. Grau, J.A. Baron, R.S. Sandler, K. Wallace, R.W. Haile, T.R. Church, G.J. Beck, R.W. Summers, E.L. Barry, B.F. Cole, D.C. Snover, R. Rothstein, J.S. Mandel
Editorial: Journal of the National Cancer Institute
Volume 99, Pages 99-100
‘Calcium supplementation and prevention of colorectal neoplasia: lessons from clinical trials’
Authors: M.E. Martinez, E.T. Jacobs