A recent study indicates that proton pump inhibitors (PPIs) such as lansoprazole (Prevacid), omeprazole (Prilosec), and esomeprazole (Nexium), which are used to treat heartburn, acid reflux, and peptic ulcers, raise the risk of hip fractures by 35% in postmenopausal women. In current and former smokers, the risk is even greater. The elevated risk of hip fracture fell when women stopped taking PPIs and essentially disappeared after two years. The findings come from a reexamination of data collected from 79,899 postmenopausal women enrolled in the Nurses' Health Study who had responded to the survey between 2000 and 2008.

The use of PPIs, including long-term use, has grown dramatically since 2003, when the Food and Drug Administration (FDA) approved them for over-the-counter sales. When participants in the Nurses' Health Study were first asked whether they took PPIs, in 2000, 6.7% reported regularly taking them; by 2008 that percentage had reached 18.9%.

"Our data suggest the importance of carefully evaluating the need for long-term continuous use of PPIs, particularly among individuals with a history of smoking," write the authors. Based on a review of seven other epidemiologic studies, the FDA plans to revise the labeling on packages of PPIs to warn users about the increased risk of hip, wrist, and spine fractures (see http://1.usa.gov/a6p7sP for details).-Carol Potera

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