older man lifting weights

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

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  1. Karmel

    Rheumy put me on Nexium 15 yrs. ago for the rheumatoid drugs I take. Am now off it with the help of Apple Cider Vinegar. 8 ml ACV 1 teaspoon honey or ginger syrup to 1 glass water. Sip all day before meals. Cut back nexium a bit each week down to 1 a week then I stopped as the AVC took over

  2. Jenny

    For a few years, off and on, I was taking Omeprazole 40mg. After reading extensively about the negative effects of PPIs I decided to discontinue taking them. Six months ago I requested a prescription for Omeprazole 20mg in place of the 40mg simply to have on hand in case of need while I adjusted my diet. More than ever I have become very, very particular about my diet …. no alcohol, no chocolate, no citrus fruit or acid producing food, no fried food, no coffee except a rare cup of decaf, no soda, no highly seasoned or spicy food, no “prepared” food. I buy organic when available. When buying anything in a jar (ex: peanut butter), a box (ex: cereal) or a can (ex: pears) I always check the Ingredients and select only the brand with ingredients that are familiar to me and which I know are not harmful. Usually those brands are more costly but well worth it when considering not only one’s health but also the cost of illness. Before going to a restaurant that is new to me I check the menu online to select what I will be ordering. Some restaurants I must bypass. I was once addicted to chocolate and coffee. I do not miss them nor do I miss anything else I once thoroughly enjoyed but cannot eat anymore. Nor do I miss taking Omeprazole. Life is good.

  3. Robert
    Mount Pleasant, SC

    I’m a male in my late 60s who was recently found to have bone loss. I had been taking proton pump inhibitors for years (stopped using them regularly about a year ago). To compound things, I also have been taking prednisone for polymyalgia rheumatica (PMR). I have worked out (cardio & strength) for 40 + years. My doctor prescribed Fossamax, but due to muscle aching & weakness in my legs, had to stop using after a couple of months.

    At this point, I’m searching for other solutions. Any suggestions other than calcium supplementation?

  4. arife r.

    He thinks that PPI use might have contributed if it interfered with the absorption of bone-building calcium.

  5. KMKR

    My mid-80’s mother was told she should have a reclast infusion. She took the pamphlet home and read it. No deep research. It revealed that anyone with a thyroid problem shouldn’t take it. She had a partial removal of her thyroid years before with no meds taken. The doctor never noticed the warning.
    My sister-in-law was diagnosed with severe osteoporosis. I gave her a Calcium Plus supplement. She reversed her osteoporosis with this product.
    I was a Tums taker for years and was on a prescribed med for a short time. I was diagnosed with bone loss in my spine. Taking the Calcium Plus product only in the morning I have increased my bone density. It is isotonic and is absorbed directly into the body if used as directed.
    Hope this was helpful.

  6. cpmt

    This has been in the news for the last 5 years. Many doctors don’t have a clue and don’t advise their patients. There have been broken bones (femur, mandible etc) in patients taking it.

  7. CT

    My 65 year old husband has been on Omeprazole, ordered by his doctor for over 10 years now . He has tried getting off it after reading that is was NEVER meant to be prescribed long term. The 2 times he tried to get off were unsuccessful.
    Last month I saw a doctor on the Doctor Oz show state she has good results getting her patients off PPI meds using Melatonin 2mg once per day, 1 hour before bedtime. We had Melatonin in the house but it was 3 mg and he started using it nightly. He is down to Omeprazole only 1 times per week and doing GREAT!!! He has taken extra strength TUMS a few times at night, that is a bonus for added calcium that PPI’s rob your body of. We plan to have him off this drug that is over prescribed and potentially dangerous next week. This has only been a 3 week process.
    Melatonin is naturally made by our bodies, but many people are deficient, the bonus here is it helps you sleep. The mechanism for it helping reflux is reported to be that it tightens the sphincter at the top of the stomach to keep the acid where it belongs – in the stomach and out of the esophagus!!!

  8. Linda

    I recently read that an acid free diet is recommended for GERD/ reflux problems.
    Please let me know how that helps; if this is a solution.
    I have suffered from reflux for many years. There are physical side effects from taking meds.

  9. Mary

    PPI’s reduce the ability of the body to metabolize B12. I strongly suspect that has contributed to the osteopenia.
    I would bet Fosamax also decreases B12. Metformin does the same.
    Dr. Hyla Cass has a book called “Supplement Your Prescription” that details numerous drugs and what nutrients they deplete.
    If you are taking any prescription drug, this book might save lots of health problems.

  10. DS

    Fosamax ? Don’t doctors keep up with the consequences of taking drugs? Try taking vitamins D and K2. Get off the PPI any way you can. Animal fats– yes saturated fats–and adequate protein is important for bone strength. Research it on the web. Good luck.

  11. Stan B.

    I have suffered from heartburn for 40 years and lived on Tums until about a decade ago. I am in my mid-sixties. I was diagnosed with a hernia at both ends of my stomach and the doc subscribed nexium. About the same time I was diagnosed with osteoporosis, especially in my lower spine. I was on Forteo for two years and calcium citrate/Vit D supplements and increased bone density 22%. I am now osteopenic.
    The nexium (40 mg) is very helpful. I am concerned because of articles such as this that I read regularly on your site. I have also started taking Vitamin B-12 and Magnesium supplements. I recently had my blood checked for those deficiencies and had none. I have tried some of the home remedies for heartburn with limited success. Despite not currently having any nexium related issues, I am concerned about what the future may hold if I continue use.

  12. Ollie W.

    Yes, all heart burn meds can cause lots of trouble. I had been taking them and had no sign of bone trouble for about 4 years, then I had a bone scan and they told me I needed something for my bones-which I doubted at the time-and could not swallow pills good because of thryoid cancer surgery so they gave me an infusing of RECLAST!
    Soft bones are nothing compared to that! Ended up in ER that night and have been having trouble ever since. That was June 4, 2012. Also started having trouble with my stomach and had a pre- cancerous polop removed and found out that heart burn meds can cause that too! But NO mention of that when the doctors told me to take it. Lots of research on these medicine can scare a person to death. And with the after effects of recast-bet it helped the cause.
    I would advise anyone that was told to take any of these medicines to do a lot of homework on them and just change lifestyle. Eat better and try not to worry to cause the heart burn. And if the doctor says you need these-go on caution!

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