Friday, July 17, 2015
Do Nexium and other heartburn medicines cause osteoporosis?
Every week, I am asked by patients if their heartburn medicine causes osteoporosis. The most effective heartburn medicines are called proton pump inhibitors, or PPIs. If you watch more than an hour of TV per week, then you have seen ads for some of them. Nexium, Prilosec and Protonix are 3 examples of these medicines.
Many of them are now available over-the-counter at reduced dosages.
Patients today are incredibly informed, and sometimes misinformed, about their medical conditions and their treatments. Most of their information is from the internet, and it's easy for patients to become unwittingly trapped in the world wide web.
The information dangling in cyberspace is entirely unregulated. Information can be made to appear authoritative and objective when it actually is a paid advertisement. Many blogs may appear to function to inform the public, when their true purpose is to serve the corporation that sponsors it. If you are learning about probiotics, for example, consider the credibility of the site if you are encouraged to purchase certain products. Caveat emptor.
I personally do not believe that Nexium can break bones, although I have read the same articles in the lay press that arouse my patients' concerns. I understand that a headline such as, Nexium Linked to Hip Fractures, will make my Nexium users so nervous that they might get wobbly and slip and chip a hip.
However, there is no convincing medical evidence that an individual user of Nexium or similar medicines has any significant risk of sustaining a fracture. The belief that they can cause or accelerate osteoporosis is derived from large, pooled medical studies that are not truly capable of concluding cause and effect, a critical point often omitted from your hometown gazettes.
However, no patient should be on Nexium, or any medication, unless certain requirements have been satisfied. Here's what runs through my mind when I am recommending a medication for a patient:
• The drug is absolutely necessary.
• I am prescribing the lowest dose of the drug necessary for the medical task.
• There is no safer alternative medication or other treatment available.
Of course, cost may be an issue depending upon the patient's insurance coverage. However, the patient's financial status should not taint the physician's recommendations. The patient, however, can indicate that the doctor's first choice is not possible, and he may choose a more affordable, but less effective option.
If you want a second opinion on any of this, try the internet. That's where I go when I need reliable medical information.
This post by Michael Kirsch, MD, FACP, appeared at MD Whistleblower. Dr. Kirsch is a full time practicing physician and writer who addresses the joys and challenges of medical practice, including controversies in the doctor-patient relationship, medical ethics and measuring medical quality. When he's not writing, he's performing colonoscopies.
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Zackary Berger, MD, ACP Member, is a primary care doctor and general internist in the Division of General Internal Medicine at Johns Hopkins. His research interests include doctor-patient communication, bioethics, and systematic reviews.
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Run by three ACP Fellows, this blog ponders vexing issues in infection prevention and control, inside and outside the hospital. Daniel J Diekema, MD, FACP, practices infectious diseases, clinical microbiology, and hospital epidemiology in Iowa City, Iowa, splitting time between seeing patients with infectious diseases, diagnosing infections in the microbiology laboratory, and trying to prevent infections in the hospital. Michael B. Edmond, MD, FACP, is a hospital epidemiologist in Iowa City, IA, with a focus on understanding why infections occur in the hospital and ways to prevent these infections, and sees patients in the inpatient and outpatient settings. Eli N. Perencevich, MD, ACP Member, is an infectious disease physician and epidemiologist in Iowa City, Iowa, who studies methods to halt the spread of resistant bacteria in our hospitals (including novel ways to get everyone to wash their hands).
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Robert M. Centor, MD, FACP, contributes short essays contemplating medicine and the health care system.
Suneel Dhand, MD, ACP Member
Suneel Dhand, MD, ACP Member, is a practicing physician in Massachusetts. He has published numerous articles in clinical medicine, covering a wide range of specialty areas including; pulmonology, cardiology, endocrinology, hematology, and infectious disease. He has also authored chapters in the prestigious "5-Minute Clinical Consult" medical textbook. His other clinical interests include quality improvement, hospital safety, hospital utilization, and the use of technology in health care.
Juliet K. Mavromatis, MD, FACP, provides a conversation about health topics for patients and health professionals.
Dr. Mintz' Blog
Matthew Mintz, MD, FACP, has practiced internal medicine for more than a decade and is an Associate Professor of Medicine at an academic medical center on the East Coast. His time is split between teaching medical students and residents, and caring for patients.
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Vineet Arora, MD, FACP, is Associate Program Director for the Internal Medicine Residency and Assistant Dean of Scholarship & Discovery at the Pritzker School of Medicine for the University of Chicago. Her education and research focus is on resident duty hours, patient handoffs, medical professionalism, and quality of hospital care. She is also an academic hospitalist.
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Michael Kirsch, MD, FACP, addresses the joys and challenges of medical practice, including controversies in the doctor-patient relationship, medical ethics and measuring medical quality. When he's not writing, he's performing colonoscopies.
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Also known as the Green Journal, the American Journal of Medicine publishes original clinical articles of interest to physicians in internal medicine and its subspecialities, both in academia and community-based practice.
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