Statin Drugs??? Is this article valid???

[Van Canna]

Interesting Bill...but what if the person is older and the taking of the ppi's is ongoing?

[Bill Glasheen]

Interesting Bill...but what if the person is older and the taking of the ppi's is ongoing?

Well maybe this will emphasize the point.

Here's an article that reviews the literature. Emphasis in red my own.

Maturitas. 2009 Sep 20;64(1):9-13. Epub 2009 Aug 11.

Proton pump inhibitors, osteoporosis, and osteoporosis-related fractures.

Fournier MR, Targownik LE, Leslie WD.

Department of Internal Medicine, Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada. mrf810@mail.usask.ca

Abstract

Proton pump inhibitors (PPIs) are among the most commonly prescribed medications today with an excellent short-term safety profile. Recently, a number of studies from a variety of data sources have reported an association between PPI use and hip fractures. However, there is not yet any direct evidence of a causal link between PPI use and the development of hip fracture. In the following paper, we will review the recent studies which have described this association between PPI use and hip fracture, and discuss the evidence supporting the likelihood of this association being causal, using data from previous work on the effects of surgical and pharmacological inhibition of gastric acid secretion on calcium absorption and bone mineral density. We will conclude by summarizing the current state of evidence on the relationship between gastric acid inhibition and the risk of fracture, and suggest management strategies for patients who require the long-term use of gastric acid inhibiting medications who also may be at risk for metabolic bone disease and fracture.

It may be more an issue of association than causality, Van. In other words, people who need PPIs may be at risk of osteoporisis. But the PPIs per se don't cause the problem.

- Bill

[Van Canna]

It makes sense...thank you. So what works best really....Prilosec or cousin Nexium?

[Bill Glasheen]

I couldn't tell you that, Van. Maybe Dr. Ian has more experience with all that.

I personally stay away from stomach acid management. Nothing like a little simethicone (anti gas) for the medicine cabinet. Works for me for virtually all problems I have. I threw the antacids away years ago.

But that's me...

If you have reflux, then PPIs make sense. Years of reflux can lead to esophageal cancer.

A personal observation (not substantiated...) is that reflux may be as much mechanical (force on the stomach) as physiologic (weak or leaky valve). The bigger the abdomen, the less room down there. But... Life and age happen. Our girlie figures don't last forever...

- Bill

[gmattson]

Try wearing a silver ring on your right thumb. . . don't laugh. . . I was suffering from a reaction to something that caused a very sour stomach and my Chimese medicine doctor gave me a silver ring to wear. Within five minutes the sour stomach (which I had been suffering with for 2 days) disappeared and a week later, still hasn't recurred.

[Van Canna]

A silver ring on the thumb for acid reflux that occasionally occurs after eating the wrong foods too late before going to sleep??

[Panther]

Again, real bummer to spend money on something and find out it was hurting you. I haven't gotten any details on what Panther's supposed supplement needs are but I don't really want them--privacy is never bad and I don't want to deprive anyone of something they think is working, but generally, whole foods are the way to go.

See... it's the placebo effect! All kidding aside, I understand... but that's why things I take are targeted to specific needs. Lunch today was a salad that came from things picked right from the garden and I'll admit to a touch of balsamic vinaigrette on it... I eat whole foods & whole grains... nothing "white" in the diet. As an MD, you know (or at least should by now) that all it takes is for some tragic event to happen, have someone get an infection (especially if it gets in the blood) and all hell can break loose in a formerly healthy body. As Bill & Van say, "Sheet happens... BAD Sheet!" So, we deal with it. That's all...

[Bill Glasheen]

A silver ring on the thumb for acid reflux that occasionally occurs after eating the wrong foods too late before going to sleep??

I'll go with a lovely lassie on the arm who occasionally appears after eating the wrong foods too late before going to sleep. May not cure the problem, but she'll sure take your mind off of your indigestion.

- Bill

[Panther]

Bill-sensei, I'm with you!



(we need a thumbs-up emoticon!)

[IJ]

Panther, good luck with repleting your specific deficiencies. Or optimizing. Ultimately it's a trial with an N of one. The stats won't be valid, but if you feel better, awesome.

Bill, not stunned by the PPI data. First, there was a small study on healthy adults on a surrogate outcome. It doesn't tell us about the hard outcomes in older sicker people. Meanwhile, PPI have recently been linked to pneumonia as well as to clostridium difficile diarrhea, which is fairly unpleasant to go through (more for those facing hospitalization; relatively uncommon in the community--for now). And they interfere with absorption of key medications, like clopidogrel, used for keeping stents in hearts open. You want your coronary artery stent to stay open. And hey, what if these were colas? There was an association with bone density there, and the take home was avoid when possible / use in moderation. The same advice is wise here. Do nonmedication things first; mother nature put the acid there for a reason.

Vitamin D is a bit different than vitamin A and E. Toxicity is very hard to create, because the body has to be able to deal with large amounts of solar vitamin D (what about the Austrailians and south african whites, for example?). And in this case, it caused falls and fractures, the opposite of what it had previously done. Authors hypothesized that patients downregulated D in response to the large dose and ended up insufficient for the year. But I agree, it's a weird strategy. Convenience is the issue here. Not an issue with people who have the wherewithall for self care.

And sorry George... I laughed. Just a little.

[Van Canna]

I'll go with a lovely lassie on the arm who occasionally appears after eating the wrong foods too late before going to sleep. May not cure the problem, but she'll sure take your mind off of your indigestion.

Well...indigestion will not happen because you will 'work off'
the late meal...and she will provide you with Ideas of where to wear the large silver ring to 'help out'

[IJ]

Oh the different PPI drugs are interchangeable. There may be a percent or two difference in a trial between relief in one group and relief in another, but you're looking at a 1 in 40-50 chance it'll make a different in one person.

Esomeprazole is a patent extender for omeprazole, which is really a mixture of two stereochemistries of the same compound (kind of like your left and right hand--same story with citalopram and escitalopam. One is more effective, that one was purified and released just in time to switch omeprazole users over before the patent ran out. Sounds good but obviously you could get the same impact with a big more of the mix than with a purified version of one form. Occasionally this does make a difference--ofloxacin can't be trusted for treating pneumonia, but the L version, levofloxacin, can.