Nexium Side Effects Anything but a Fractured Fairy Tale

Washington, DCIt’s a Catch 22 for doctors and their patients when it comes to treatment options for heartburn and those options that patients find most convenient and easiest to maintain. To wit, a PPI medication such as Nexium is fast and effective in relieving symptoms associated with heartburn. For many Americans, heartburn is a chronic problem. Yet taking Nexium and other PPI drugs for more than a year is not only frowned upon by health regulators, overuse of Nexium can also foster Nexium fracture risk.

PPI, which stands for proton pump inhibitor, has proven to be an effective treatment for acid reflux, commonly known as heartburn. For those who suffer from the more serious chronic reflux, known as gastroesophageal reflux disease (GERD), changes to diet and eating habits may not be enough on their own to ease symptoms, and PPIs are often prescribed.

However, the US Food and Drug Administration (FDA) has long since advocated that PPI drugs, including Nexium, should be used for no longer than 12 months, lest there be a greater risk of proton pump inhibitor side effects.

Those PPI side effects, according to Harvard Men’s Health Watch (2/1/13), include the potential for bone fractures. And here’s why: reducing the acid level of the stomach through use of PPIs has been linked to lower absorption of various nutrients, including iron, vitamin B12, magnesium and calcium. Calcium is of particular concern, because reduced absorption could lead to weaker bones and a greater risk of bone fractures.

Various reports related to Nexium side effects suggest that long-term users of PPIs have, indeed, experienced a greater risk for bone fracture. One advocate for natural alternatives to PPIs noted in a published report (The Record Herald, 2/13/13) that she was surprised to have suffered a broken wrist at the relatively young age of 56. “My mom, who is in assisted living, also recently suffered from a broken hip,” Maureen Reynolds said.

“I thought our family was just prone to these fractures until I read an article that stopped me dead in my tracks,” Reynolds continued. “It talked about a recent FDA warning that said if you take certain antacids like Nexium [among others], that there was an increased risk of hip, bone and spinal fractures. [The report] also said that these medications were not meant to be taken for more than one year for prescription, and for over-the-counter versions (OTC), no more than three, 14 continuous day treatments per year unless instructed by a physician. I almost fainted when I read this because my Mom and I both had been taking [PPIs] daily for years.”

The Harvard Men’s Health Watch notes the risk for weakened bones resulting from nutrient deficiency stemming from PPI side effects in men is low. “PPIs can affect certain vitamins that require acid to help with absorption, such as vitamin B12,” said Dr. William Kormos, editor in chief of Harvard Men’s Health Watch and a primary care physician at Harvard-affiliated Massachusetts General Hospital. “Although actual ill health effects from vitamin deficiency are unusual, it is reasonable to periodically monitor blood levels of B12 in patients on long term PPI.”

Kormos, in the report, did not quantify “long term.” And while the risk for Nexium bone fracture may be less prevalent in men than women, the fact remains there are those who feel consumers are over-medicated at the behest of pharmaceuticals plying their wares to patients and their physicians promising relief through convenience.

As reported by The Globe and Mail (4/26/13), most physicians will refrain from prescribing a drug such as a PPI without evidence or a convincing argument that it will help the patient. However, said Alan Cassels, a pharmaceutical policy researcher at the University of Victoria, “the information on whether it’s of benefit versus harm is often weighted in the direction of the benefit.”

Cassels, in comments published in The Globe and Mail, noted pharmaceutical guidelines issued to physicians are authored by researchers having received some form of compensation from drug companies, “and we accept this as a normal state of affairs.”

Cassels noted the effectiveness of PPIs such as Nexium in the reduction of stomach acid causing GERD, but also noted that such drugs often mask poor lifestyle choices. He also articulated the risk for PPI bone fractures associated with overuse of PPIs.

Which takes us back to the Catch 22 that is the critical balance of benefit and risk amidst the cradle of convenience. Nexium helps with heartburn. But using Nexium or other PPIs to fight heartburn long term and beyond than 12 months is an easy fix that could lead to the hard reality of serious PPI side effects, including Nexium fracture risk. The Harvard Men’s Health Watch put it this way: “Proton pump inhibitors (PPIs) are safe for most people, but also have potential risks you should know about...”