February 3rd, 2012
Podcast 144: Hip fractures, PPIs, and smoking history in postmenopausal women — increased risks
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PPIs are back on our radar, and this time it’s their regular use among postmenopausal women.
A BMJ article examines data from the Nurses’ Health Study to show a significantly increased risk for hip fracture among postmenopausal women with any smoking history. Never-smokers showed no statistically significant increase.
Now that proton pump inhibitors have been available over-the-counter for the better part of a decade, should clinicians be asking about their patients’ smoking history in concert with asking about how they handle heartburn?
Links:
BMJ article (free)
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The use of PPIs which produces achlorhydria on a 24 hour basis, inhibits the absorption of the most common forms of calcium supplements, so patients should be advised to use calcium supplements that do not need gastric acid. In addition, they prevent the absorption of B-12 from food sources. After a period of time, depending on liver storage, B-12 deficiency can gradually develop. Patients on PPIs, therefore should be tested regularly for B-12 blood levels or prophylactically given 1 mg. orally or an injection monthly. Routine neurological exam should be done.