Some heartburn drugs may contribute to bone fractures in children

You wouldn’t think a drug your child was taking would influence whether they suffered broken bones, but there is evidence that proton pump inhibitors may contribute to them. If your child is on one, they should not stop taking it without discussing the risks and benefits with a doctor.

Proton pump inhibitors, or PPIs, are often available over the counter as well as by prescription. Common examples include:

  • Omeprazole (Prilosec)
  • Lansoprazole (Prevacid)
  • Dexlansoprazole (Dexilent)
  • Rabeprazole (Aciphex)
  • Pantoprazole (Protonix)
  • Esomeprazole (Nexium)

It’s relatively unusual for kids to be on these heartburn drugs, although they are approved for children over the age of one. They are generally prescribed for gastroesophageal reflux disease, which involves persistent regurgitation of stomach acid and food.

PPIs may increase risk of bone fractures

The researchers examined Swedish government health records for 231,866 kids. Half of them had been prescribed PPIs. Over the course of a two-year follow-up period 5,354 children who had taken PPIs broke bones, as opposed to 4,568 who did not.

Overall, that showed an increased risk of fracture of 11% associated with the drug. Specifically, PPIs were associated with an 8% increase in broken arm bones, a 19% increase in broken leg bones and a 51% increase in other breaks. No association was found with skull or spinal fractures.

This could be because PPIs have been associated with reduced absorption of calcium and may cause other bone health problems such as osteoporosis.

It’s important to understand that the study did not control for bone density or physical activity. Those factors may be important in the incidence of bone fractures.

“We’re not saying that all children should avoid P.P.I.’s,” said the study’s lead author, “but this is a small increased risk. Where these drugs are necessary, the doctor should keep an eye out for these kinds of events.”

The study appeared in the March edition of JAMA Pediatrics.

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