Most people think that weak bones are a problem of older women. That is not necessarily the case. Medications can make men as well as women more susceptible to osteopenia. What is the best way to build bone strength?
Q. No one would ever suspect that I have just been diagnosed with osteopenia (weakened bones). I am a man in remarkably good health with blood results to kill for. I work out three times a week at the gym, 45 minutes of aerobics plus weight work.
I have read that PPI acid reducers can cause osteoporosis over time and wonder if that is my problem. I have been on mega-doses of these drugs for years to treat reflux.
The rheumatologist I saw yesterday prescribed alendronate (Fosamax) and calcium for the bone loss. He thinks that PPI use might have contributed if it interfered with the absorption of bone-building calcium.
The opinions I found online are divided. Can PPIs lead to osteopenia?
A. It’s no wonder you are confused about acid-suppressing drugs such as esomeprazole (Nexium), lansoprazole (Prevacid) and omeprazole (Prilosec) and their link to bone loss. Experts are divided on this question. A study published in the journal Osteoporosis International (online, Feb. 10, 2016) concluded that:
“GERD [gastroesophageal reflux disease] with PPI use is associated with an increased risk of osteoporosis.”
We worry that such drugs may interfere with magnesium and potassium as well as calcium absorption. An article in the Journal of Digestive Diseases (Aug. 2014) reveals the serious consequences that can occur when PPIs lead to low magnesium levels. Symptoms may include muscle cramps, confusion, fatigue and depression. Magnesium is also crucial for bone strength.
Whether alendronate will undo the damage is not clear. You may wish to review this article titled: “Bone Fracture and the Interaction Between bisphosphonates and Proton Pump Inhibitors: A Meta-analysis” (International Journal of Clinical and Experimental Medicine, Apr. 15, 2015).
We are sending you our Guides to Digestive Disorders and Osteoporosis for more information on your medications and other approaches to managing your complex conditions. You may also find our one-hour radio interview on Bone Vitality quite revealing. There are many ways to build bone strength and given your situation you need an effective strategy moving forward.
Revised: April 7, 2016