The Catch 22 of PPIs and Nexium Fracture Risk

September 30, 2013, 10:30AM. By Gordon Gibb

Washington, DCWhen it comes to taking a proton pump inhibitor (PPI) to combat acid reflex, you’re sometimes damned if you do and damned if you don’t. While that old chestnut may appear like a tired cliché, in practice it speaks to the issues patients have with PPIs like Nexium, together with the various adverse reactions associated with esomeprazole, including Nexium fracture risk.

Digestive disorders remain a scourge for millions of Americans who suffer from over-production of stomach acid, leaving them to deal with acid reflex and chronic heartburn. PPIs such as Nexium work to suppress the production of stomach acid quite effectively. However, various Nexium side effects and similar adverse reactions associated with PPI medication have given the US Food and Drug Administration (FDA) pause to consider PPIs as short-term response to acid reflux.

That’s a hard pill to swallow for any chronic sufferer of heartburn or acid reflux, for whom PPIs such as Nexium work well. Why come off something that works?

There are plenty of reasons, according to a report published in The Lawton Constitution of Oklahoma (9/2/13). The Journal of the American Medical Association (JAMA 10/27/04) first raised a red flag with regard to PPI side effects and a risk for pneumonia. Fourteen months later, JAMA was out with another warning with regard to a higher risk for C. difficile (12/21/13). An increased risk for the serious intestinal infection was linked to the role PPIs play in suppressing stomach acid. Tamping down stomach acid may mitigate symptoms of acid reflux and heartburn, but at the same time a reduction in stomach acid also serves to reduce the protective capacity for stomach acid to eradicate unwanted bacteria, providing a window for potential infection.

2013 has proven to be a bit of a watershed for revelations regarding proton pump inhibitor side effects. In April, JAMA Internal Medicine (4/8/13) revealed a study that found older persons on high doses of PPIs for acid reflux et al were more likely to die in the year following discharge from hospital. The potential cause for that may be explained by research that came out later in the year. Circulation online (7/3/13) published research that suggested PPIs foster a reduction in the flexibility of blood vessels, accomplished through the interference of nitric oxide production. Nitric oxide was described as a compound found naturally in the body that helps to relax blood vessels.

It was also in July that the Expert Review of Clinical Pharmacology (7/13) weighed in with a concern over an increased likelihood for magnesium deficiency. Such proton pump inhibitor side effects can lead to Nexium hip fracture and other fracture risks.

Bone fractures cannot be taken lightly, especially in the elderly. Nexium fracture risk, especially to the hip, can amount to a serious situation.

But back to the FDA and the Catch 22 that exists with PPI side effects. The federal drug regulator has determined that PPI drugs such as Nexium should only be used for short-term treatment of gastrointestinal issues. Ideally, no longer than 12 months. However, many chronic sufferers of acid reflux and heartburn have used PPIs for years, due to the relief they provide.

But here’s the rub: were a long-term user of a PPI such as Nexium decide to follow the advice of the FDA and discontinue use of Nexium, the possibility exists of a whole new breed of Nexium side effects. Specifically, over-production of stomach acids that can eclipse the initial symptoms for which Nexium was prescribed in the first place.

According to research first published in Gastroenterology (9/09) and more recently in the Scandinavian Journal of Gastroenterology (5/13), the body will often respond to the sudden discontinuation of medication such as Nexium by producing excessive amounts of stomach acid for weeks, and sometimes months. The suggestion, therefore, is that a drug holiday - either temporary or permanent - from a proton pump inhibitor might be best accomplished by way of a gradual discontinuation, in concert with monitoring by a physician.

But you’re damned if you do, and damned if you don’t. Take Nexium for relief of gastrointestinal issues such as acid reflux and enjoy relief from heartburn, while introducing risks to the heart through cardiovascular effects and other side effects, including Nexium fracture risk.

Stop using it, and proton pump inhibitor side effects may continue in the form of additional bouts of acid reflux and heartburn that could be worse than the symptoms you originally started with.

And wouldn’t it have been nice to have known all this stuff years ago, before you took the plunge with Nexium? Because thanks to Nexium side effects, life without the drug could be just as bad as life with it…