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Drugs commonly prescribed to fight acid reflux disease may significantly increase the risk of fractures in people suffering from osteoporosis, a study by Canadian researchers reveals.

The study, published today in the Canadian Medical Association Journal, sheds light on how proton pump inhibitors, a class of drugs designed to treat gastroesophageal reflux disease, also known as acid reflux, can lead to potentially life-altering consequences among some patients.

Although more research is needed to understand the study's implications, the findings should prompt medical professionals to re-evaluate how often, and for how long, they prescribe those drugs to patients, according to lead researcher Laura Targownik.

"There's a lot of patients who are using these medications who may not need these, or may [be able to] use a different medication that doesn't have these side effects," said Dr. Targownik, assistant professor of medicine at the University of Manitoba.

The findings also add fuel to other recent studies, which have suggested an association between proton pump inhibitors and osteoporosis-related fractures. People with osteoporosis, a disease that affects bone density primarily in older women and men, face a substantially elevated risk of hip, wrist, spinal and other fractures. But those risks could be greatly enhanced if osteoporosis sufferers also take proton pump inhibitors, such as Nexium and Pariet, according to the study.

Researchers compared nearly 16,000 cases of osteoporosis-related hip, wrist or spinal fractures in Manitoba from 1996 to 2004 with a control group of about 47,000 without fractures.

They found that patients who took proton pump inhibitors for seven or more years were four times more likely to suffer a hip fracture than the control group. They also found that patients who took the drugs for five years or more were nearly two times more likely to have either a wrist, hip or spinal fracture.

The researchers examined the risk of hip fracture separately because it can have such devastating effects on a patient's life, Dr. Targownik said.

"If someone has a hip fracture, their chance of dying is 20 per cent in six months," she said. "Even those who don't die as a result of it, they're still often left with significant disability [and] loss of independence."

Although the drugs aren't associated with a major increase in fracture risk within the first few years of starting the medications, the findings are significant because many people take the drugs for extended periods of time to treat their symptoms, according to the study.

"Furthermore, use has been increasing in recent years, likely because of a number of factors, including increasing affordability with the emergence of generic and over-the-counter formulations," the study said.

It's unclear why proton pump inhibitors may be tied to a higher risk of fractures, but the study suggests it may be because the drugs, which inhibit the production of acid, also accelerate bone mineral loss.

Regardless of the reason, the mounting evidence linking fractures and proton pump inhibitors raises questions about whether certain patients should take the drugs, Dr. Targownik said, particularly since other research has linked the drugs to an increased risk of C. difficile and pneumonia.

"I think patients who are on these medications should discuss it with their physician," she said. "Can these medications be safely discontinued?"

Dr. Targownik has been paid for research conducted for Janssen-Ortho Inc. and AstraZeneca Canada Inc., which market the proton pump inhibitors Pariet and Nexium, respectively. She has also served on Janssen-Ortho's advisory board, as well as for the Canadian Agency for Drugs and Technologies in Health.

The study was funded by an operating grant from the Canadian Institutes of Health Research, a government agency.