Lansoprazole and osteoporosis risk

[Egghead68]

Hi - developed a hiatus hernia and severe acid reflux about a month ago. The discomfort was so severe I had been seriously considering private surgery, even though it can make thins worse. Anyhow GP reluctantly gave me a trial of lansoprazole a few days ago which seems to be a miracle cure. I feel wonderful on it and all my symptoms have gone (apart from a bit of burping). Problem is that he says he won’t prescribe it for more than a month because of the osteoporosis risk (especially as I already have osteopenia). I really can’t face going back to how things were. Does anyone know anything about this or any ways to mitigate the osteoporosis risk? I know of lots of people who are on long-term omeprazole or lansoprazole so I think the risks can’t be all that high.

[LauraMontreville]

Place marking to read (and panic over!) later

[Egghead68]

Thanks BrilyPribble. I take high dose B12 anyhow (am vegetarian).

I am sure that Barrett's oesophagus is absolutely horrible and I am keen to avoid it. Severe reflux is soul-destroying enough.

Other answers: I do plenty of resistance exercises (5+ classes a week - not that they prevented me developing osteopenia) and my osteopenia is mild (0.5% 10 year risk of osteoporitic pelvic fracture etc as stated further up thread) T-scores are between -1 and -2 depending on area I think (worse on right due to leg length difference).

I take a calcium supplement any how (osteocare). My heart's pretty healthy so I'll just have to take the hit (everything is a trade-off).

I'm aware of the research showing that under 30 days PPI use at a time is safe. I agree that it sounds like a good compromise to use it in 30-day stretches when my reflux is really bad and rely on other types of drug in between (as well a wedge pillow, small meals, no food 3 hours before bed or exercise). I hope my GP will agree.

Thanks so much everyone for your help.

[BrillyPribble]

Long term PPI use can also lead to b12 deficiency so you should be taking a b12 supplement as well (b12 needs a high stomach acidity level for absorption).
My FIL has Barrett's oesophagus and it's a really miserable condition, he's had to have pre-cancerous cells removed twice.

[JinglinghellsBells]

@Egghead68 There are several reasonably recent studies on this. Here is one of them www.ncbi.nlm.nih.gov/pmc/articles/PMC4525469/

The conclusion (read it) is that using the drug short term ( the research was mainly over 30 days) does not have much effect on calcium absorption. However, it also says that the best way to get calcium is through milk and cheese as these appear to have greater bioavailability compared to other dairy sources.

You might like to try your drug for 30 days at a time and then see how you feel? Meanwhile you might try doing resistance exercises to build up your bones.

If you had a DEXA scan what extent is your osteopenia? Do you know your T-score?

[Egghead68]

Thanks JinglinghellsBells. I will take look at the website.

[JinglinghellsBells]

@Egghead68 The reason is that without stomach acid, your guts can't absorb calcium. So taking more calcium while on Lansoprazole or indeed any meds which reduce stomach acid, is a waste of time. Also, supplements of calcium can cause calcification of the arteries or kidney stones. You ought not to supplement with large amounts such as Ad Cal.You can buy Osteocare which is the same stuff, of course but you won't absorb much while using those drugs.

@Egghead68 We've come across each other on the meno forum here :) I had severe osteopenia and have now reversed it. FWIW I am a health writer and have written extensively on osteoporosis and menopause, as well as doing research for my own benefit. You can pay for a bone density scan- there is info on the meno forum and indeed i think you said you'd had a DEXA scan this way (unless I'm confused?)

Adcal is a huge dose of calcium and the research shows it may cause heart disease. It's best to get calcium from food.

Maybe you need to have a good read of all the info on the Royal Osteoporosis Society website.

[Egghead68]

It seems Lansoprazole and other PPI drugs may have more serious risks than just osteoporosis:

www.nhs.uk/news/medication/heartburn-drugs-linked-to-premature-death/

[Egghead68]

Ooh - I think I’ve found a site for buying Adcal-D3 OTC. I’ll stock up.

[Egghead68]

Thanks Fairy - that’s really interesting.

Ipswich - I asked for it but the GP put my bone density figures through her algorithm and I didn’t meet the criteria. She said to do more exercise (I already do 5+ classes - weights, circuits, spinning etc. a week).

[ipswichwitch]

If you have osteopenia have they not put you on calcium and vitamin D?

[EskewedBeef]

My mum took it for years when she was on a high dose of steroids. She was prescribed Calcichew to take every day as well.

[Fairylea]

Not sure why there’s a dot before 4K!

[Fairylea]

Not sure if this will be of interest but I have Addison’s disease which means I have to take daily steroids for life and I am on an Addisons forum with .4K members. Almost everyone on it - including me - takes high dose omeprazole or Nexium (I know Nexium is a brand name but I can’t spell the actual drug!) None of us are worried about taking them long term because the risk of stomach ulcers and stomach discomfort really outweigh the risks. We all take high dose calcium, vitamin D and just hope for the best! Oddly enough even though steroids also weaken your bones if taken over a long period osteoporosis etc is hardly ever mentioned on the forum. (And it’s a very very vast range of ages and length of time people have had Addison’s etc).

[Egghead68]

Pineapple - I don’t know. It might depend on other factors too. Probably worth asking your GP.

[Egghead68]

Thanks Fairy - I asked my GP before for Adcal but they said I didn’t meet criteria. That was before I took Lansoprazole though.

Thanks Temporary. That’s what the GP is hoping but I am sceptical unfortunately - it’s really severe and didn’t settle with anything else. Fingers crossed though.

[TemporaryPermanent]

It's possible for a short course of a ppi like lansoprazole to improve things so that you can come off it I think.

[PineappleTits]

I have a 2cm oesophageal sliding hiatus hernia and severe reflux. I take 30mg lanzoperazole a day and it helps massively. I'm currently pregnant and unable to take them and have been taking OTC ranitidine which takes the edge off. I did not know about the osteoporosis risk! Should I look into getting something else when I've had the baby do you think?

[TheFairyCaravan]

I take Omeprazole because I take Naproxen on a daily basis due to a chronic, painful disability. I, also, have Osteopenia. I am on Adcal-D3 750mg/200 I.U twice daily which is prescribed by my GP, though.

[Egghead68]

Causes a lot of pain and discomfort for such a small thing.

[Egghead68]

Mine is 2cm but they didn’t tell me if it is sliding or fixed.

[justasking111]

mine is 5cm sliding variety, not that I know what it means.

[leavingtomorrow]

I take ranitidine for my hiatus hernia, not everyday but it certainly controls it. Mine is a 3cm sliding variety

[RuthW]

I've been on it for years. I'm also a dispenser and work in a practice. Loads of patients have also been on it for years.

[Egghead68]

GORD/GERD - I never know the difference.

Should say my osteopenia is mild (0.5% 10 year risk of osteoporotic hip fracture and 3-4% risk femur fracture I think).

[Egghead68]

Thanks both. I do lots of weight-bearing exercise and take “osteocare” supplements already. I know there’s a small risk of Barrett’s oesophagus and then throat cancer with untreated GORD plus untreated GORD is so bloody miserable. I’ll discuss both the ranitidine option and the staying on a PPI with increased calcium with my GP (and hope he will support the latter).