Peptic ulcers are very common. Doctors say that in the United States, almost 1 in every 10 people will get an ulcer at some time during their lives.An ulcer is a sore, which means it's an open, painful wound. Peptic ulcers are ulcers that form in the stomach or the upper part of the small intestine, called the duodenum (pronounced: doo-uh-dee-num).

Not long ago, the common belief was that peptic ulcers were a result of lifestyle. Doctors now know that a bacterial infection or medications — not stress or diet — cause most ulcers of the stomach and upper part of the small intestine (duodenum). Esophageal ulcers may also occur and are typically associated with the reflux of stomach acid.

Treatment of peptic ulcer the main goal is eradication of the organism that causes the problem. Multiple regimens are effective and usually include either an H2 receptor antagonist such as famotidine (Pepcid) or nizatidine (Axid) or a proton pump inhibitor such as omeprazole (Prilosec) or esomeprazole (Nexium) to suppress acid.

But it might be awful that 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).

"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.

The term "hip fracture" is commonly used to refer to four different fracture patterns and is often due to osteoporosis; in the vast majority of cases, a hip fracture is a fragility fracture due to a fall or minor trauma in someone with weakened osteoporotic bone.The mortality following a hip fracture is between 20% and 35% within one year.Approximately 320,000 hospitalizations occur each year due to hip fractures in the US.

Most hip fractures occur as a result of low-energy falls in elderly patients. Falls are uncommon in young adults due to better balance and strength and when they do occur, they usually do not cause the "hip fracture" pattern of injury that is commonly seen in the elderly. The classic clinical presentation of a hip fracture is an elderly patient who sustained a low-energy fall and now has pain and is unable to bear weight. On exam, the affected extremity is often shortened and externally rotated.

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."

"Proton pump inhibitors such as Aciphex, Nexium, Prevacid, Prilosec and Protonix may decrease calcium absorption;long term use have possible risk of hip fracture/bone mass/osteoporosis for elderly"   User Opinions

ken :   the research talks about high doses making one more susceptible to hip fractures - what is considered a daily high dose of aciphex? would appreciate replies ken kapreston@aol.com

Marcy Rivera :   I hated the Prevacid, and tolerated the Nexium and AcipHex much better. I think that diet is a huge part but that it's a catch 22 in that you are in so much pain that you would do anything just to enjoy your life for one more day (so you binge) since it feels like you may never get to sleep, swallow, or enjoy the same foods again. I have heard of people getting over this after 2 months of meds, bland diet, and no alcohol or carbonated drinks. A total of 6 months to completely recover in total.

Robyn C. :   I started having GERD symptoms when I was 26 years old and have been taking Prilosec and now Prevacid for the last 12 years. I am concerned about the connection with osteoporosis but eventually knew something negative would come about after these medications had been on the market for a few decades. The question you should ask yourself is how bad is your GERD? I have a severe case and had surgery in 2006 at Stanford and I am still having problems. I would not be able to function without taking Prevacid everyday and I still have acid coming up in my throat everyday. In my individual case I think I still have plenty of acid to absorb the nutrients I need. I know many people who are taking PPI's and don't really need them. Have you had an endoscopy, PH study and motility test to determine how bad your acid reflux really is? If you are taking a PPI and have not had the medical tests to confirm your disease you may be taking a medicine that you really don't need. If you don't ne...

Barbara D. :   I too am a long time sufferer of GERD and have been on PPI's, most recently Protonix. At 56 I have just been told that I have osteopenia of my right femur. I only recently learned of the connection between these meds and the increased risk of osteoporosis. How ironic that the treatment are meds that can't be tolerated by people with GERD.

Hoya J.A. :   I'm 35, been suffering GERD for 7 years. Ranitidine (Zantac) worked much better than proton pump inhibitors for me. But to me is produces agitation and sort of mental confusion (dementia I read somewhere). I now vary between lansoprasole and espomeoprasole, and a rest period (where GERD is a nightmare). Eating habits and/or regular exercise did not help at all, moreover, doing abs increased stomach pressure and GERD worsened. There's a technique applying pressure right below your ribs and inhaling to reposition your stomach if you suffer hiatal hernia. Thanks for the advise about measuring bone density and calcium supplements!

ccwms :   I've been on Protonix for over 6 years. I had GERD and a narrowing of the esphagus which was widened at the time of my endoscopy. My father died of esophogeal cancer. Even though I showed no signs of Barrett's, I was told I needed to be on it for life to prevent the narrowing again. Two years ago my BDT was fine, now I have osteopenia. I was put on Fosamax - only took one dose and had multiple side-effects including narrowing/blockage of esphogus. So which do I choose - to die of esophogeal cancer, or have crippling osteoporosis?? Not a choice I should have to make!

Patricia :   61 yrs old. On Prilosec six months for GERD after removal of gallbladder. Never had so much "bone pain" which seems to increase in severity by the week. I stop Prilosec for a few days and manage foods wisely. Somehow the "bone pain" eases. Could Prilosec and bone pain be related? Is this in my head?

Valerie :   I just started Nexium a couple of months ago and it is a Godsend - I have GERD pretty bad - have had nighttime - in my sleep occurances. I am 55 and take supplements and in spite of we shouldn't - I do eat dairy although not excessively. I drink soy milk in the AM - take Nexium 1-2x's a day - (40 mg.) I'll take my chances with the hip fracture thing - I exercise daily and swim at the Y - recent bone density test looked - according to my doc - "great". Living with GERD is NOT an option - I'd rather have a bone problem in the future than esophageol cancer

gretchen :   i've been taking protonix for about 6 years for barrett's esoph. and gerds. i'm 57 y.o. and just had my 1st bone density test. results were alarming (to me) in that they showed severe osteoporosis. my physician was unaware of any link between ppi's and ca absorption. he actually said to me "what difference does it make anyway?" the bones can't get better whether you continue to take a ppi or not. he recommended that i forget about ever snow skiing again (which i do frequently) and said that i needed to change my lifestyle significantly to avoid chances of fracture. he said that i'm a broken bone just waiting to happen. considering that there is no familial history of osteoporosis inmy family, i'm stunned and in shock!!

Sandy :   After a bone mass scan at the age of 53 I was told I had the bones of a 35 year old . At 54 years old I started taking Prevacid and later Prilosec once a day.I'm now 61. This week I was told I have osteopenia after undergoing a DEXA scan. No one in my family has osteoporosis. I have been on estrogen replacement 14 years. Are proton pump inhibitors to blame? Strange...

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