Add Antidepressants and Acid-blockers to the List

We’ve known for decades that certain medications can contribute to bone loss. They include steroids such as prednisone, and calcium-channel blocking drugs for hypertension such as Procardia and Norvasc. Now we can add two other drugs to the list: acid-suppressing drugs used for heartburn, such as Prilosec, Prevacid and Nexium; and selective serotonin reuptake inhibitor (SSRI) antidepressants such as Celexa, Zoloft, Prozac and Paxil.

Heartburn or Hip Fracture?
The heartburn drug study examined the medical records of 13,000 people who had suffered a hip fracture, and compared them with 135,000 similar people who had never had a hip fracture.

Those who had used the family of heartburn drugs known as proton pump inhibitors (PPIs) for more than a year had a whopping 44 percent higher risk of hip fracture. Those taking the drugs at the highest doses for the longest period of time had the highest risk of hip fracture. Critics of the study point out that so-called “retrospective” research looking back at medical records tends to be less accurate, but even if the PPI users had a 22 percent risk instead of 44 percent risk, it would still be a very high number.

It’s theorized that the PPIs probably cause bone loss that leads to hip fracture by interfering with the absorption of nutrients that build bone, such as calcium and other minerals.

The PPIs can be a very useful short-term solution for stopping heartburn, but it’s important to make the lifestyle changes that can prevent heartburn and get off the drugs. For more information on preventing heartburn, here’s an article by Dr. John Lee and myself: What Your Doctor May Not Tell You about Heartburn.

The Antidepressants
The research on SSRIs and bone loss is smaller but still important. This was a Canadian study done at McGill University that began with a pool of 5,008 randomly selected people over 50 and followed them for five years. Of that group, 137 were taking SSRIs, and they were found to have 2.1 times the risk of bone fractures. Although this was a relatively small group taking the SSRIs, the researchers took into account many other risk factors for bone fractures and still got the same result. Some critics argue that people who are depressed fall more often, but the study showed that the SSRI users had “fragility” fractures, meaning broken bones caused by relatively minor incidents like falling out of bed—in other words, it didn’t take much for their bones to break.

The Prescription Drug Triple Bone Whammy
It’s not uncommon at all to find senior citizens on multiple prescription drugs. Some of the most common include prednisone, calcium channel blockers and proton-pump inhibitors—all now linked to bone fractures. There are many reasons to avoid prescription drugs in general, and now we can add bone loss to the list. Prescription Alternatives, a book I wrote with Dr. Earl Mindell, gives many alternatives to prescription drugs, as well as detailed descriptions of common drug side effects and interactions.

Yang YX, Lewis JD et al, “Long-term proton pump inhibitor therapy and risk of hip fracture,” JAMA. 2006 Dec 27;296(24):2947-53. University of Pennsylvania School of Medicine.

Richards JB, Papaioannou A et al, “Effect of selective serotonin reuptake inhibitors on the risk of fracture,” Arch Intern Med. 2007 Jan 22;167(2):188-94. Division of Endocrinology and Metabolism, Department of Medicine, McGill University, Montreal, Quebec, Canada.