The People's Perspective on Medicine

Drug Interaction Could Lead to Disastrous Osteoporosis and Bone Fracture

Antidepressants (SSRIs), bone drugs (BPs), plus acid suppressing meds (PPIs) will likely increase the risk for bone fractures. Be careful of the combo.
Hot flash menopause flush heat

Doctors may not always keep up with the latest research on drug side effects. To an extent, that is understandable. A busy family practice physician, internist or OB/GYN may have to see more than 20 patients a day. By the end of an exhausting workday overseeing so many patients, there is not a lot of time or energy left to review the medical literature.

Unfortunately, however, that can put patients at risk. The following question reveals what can happen when two popular drugs are prescribed together.

Q. I went to my doctor with menopausal symptoms of flushing, dizziness, queasiness and headaches. He prescribed an antidepressant called sertraline that made the queasiness worse. He then added omeprazole (Prilosec).

The sertraline has made me scatterbrained and fatigued. I hate taking so many drugs and wonder if there is another option to help me get through menopause.

A. We are concerned about the combination of the antidepressant sertraline (Zoloft) and the acid suppressor omeprazole. Research suggests that both drugs can contribute to weakened bones, a significant hazard after menopause. The link between omeprazole and a greater risk of bone fracture has been known for some time (Current Opinion in Gastroenterology, Nov., 2012).

Epidemiologists recently found an increased possibility of bone fractures associated with SSRI-type antidepressant drugs such as sertraline (Injury Prevention, online June 25, 2015).

When 1+1 May Equal 3

This is a paradox that really scares us. If a woman were taking an acid-suppressing drug such as esomeprazole (Nexium), lansoprazole (Prevacid), omeprazole (Prilosec) or pantoprazole (Protonix) and then were tested for bone mineral density, she might be found to have osteopenia (early bone weakness) or osteoporosis. Out could come a prescription for a category of drugs called bisphosphonates.

Some Common Bisphosphonates:

  • Alendronate (Fosamax)
  • Ibandronate (Boniva)
  • Risedronate (Actonel)
  • Zoledronate (Zometa)

Bisphosphonates (BPs) are prescribed to build bone, reverse osteoporosis, and prevent fractures. But researchers have discovered that the combination of a BP-type drug and a proton pump inhibitor (PPI) like esomeprazole or lansoprazole may increase the risk for fractures (International Journal of Clinical and Experimental Medicine, April 15, 2015).

Double Whammy Drug Interaction

This is a double whammy interaction. That is because people taking bone building bisphosphonates often experience heartburn as a side effect. Someone taking Boniva or Fosamax might complain to a doctor that her stomach hurts. A likely response: “Here is a prescription for esomeprazole” or some other PPI.

So someone taking a drug to build bones might easily end up on a PPI. And someone taking a PPI might end up on a bisphosphonate to treat weakening bones. Regardless of the reason, the combination could be disastrous because of the increased risk for a bone fracture down the road.

The Triple Whammy and Bone Fracture

If a woman were taking an SSRI-type antidepressant like sertraline (Zoloft), fluoxetine (Prozac), paroxetine (Paxil) or a similar medication like duloxetine (Cymbalta), the risk for a fracture might increase substantially. (We have written about the research outlining this problem here.) Such drugs are now being prescribed more frequently for menopausal symptoms such as night sweats or hot flashes in addition to easing depression.

Discontinuation Disaster

There is a problem with stopping antidepressants quickly, though. Researchers call it “discontinuation syndrome.” Discontinuing such drugs suddenly can lead to dizziness, nausea, sweating and “brain zaps” that feel like electric shocks. Other complications include irritability, anxiety, agitation, insomnia, ringing in the ears, headache, fatigue and seizures.

You may wish to discuss these potential problems with your doctor and see if she can come up with a plan to help you taper off sertraline gradually.

We are sending you our Guides to Dealing with Depression, Digestive Disorders and Menopause so you can read about sertraline as well as many other options for managing menopause or overcoming heartburn.

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    About the Author
    Joe Graedon is a pharmacologist who has dedicated his career to making drug information understandable to consumers. His best-selling book, The People’s Pharmacy, was published in 1976 and led to a syndicated newspaper column, syndicated public radio show and web site. In 2006, Long Island University awarded him an honorary doctorate as “one of the country's leading drug experts for the consumer.” .

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    Hello All,

    I have just been reading through some of your stories and found myself in a similar situation, I have been taking Pantoprazole for a few years now as well as Quetiapine and Venlafaxine I recently had a bone density test and I have been diadnosed with (severely reduced bone density) osteoporotic, I am 54 and absolutely devastated by this finding and it explains why I have had a broken ankle, broken finger and broken ribs on both left and right sides, my Dr said my level of Osteoprosis is not normal for my age and that I am too young, from my understanding taking Pantoprozale was something that my Dr should have been monitoring for my Vitamin D and calcium levels ??? which has not been done and with my busy lifestyle it totally slipped my mind to get tested, so my bad but I also feel my Dr has not done her job properly either by going through my file when I am in for an appointment and doing a checklist with me of (how are you going on so and so tablets) its been a while we should do a blood test and check your levels of etc etc etc, so after my results I woke up this morning and thought to myself, ok I know whats caused the Osteoprosis now its my reflux medication, my Dr is checking me for Celiac disease, but I know I don’t have that because I don’t have an issue with Gluten.

    The range of “normal” thyroid tests seems to be different at different labs, and many physicians will only order a TSH test, which gives an incomplete picture.

    why are so many women using drugs to relieve menopausal symptoms?? We are becoming so drug dependent it is ridiculous– just deal with it and go about your life!!

    My thoughts exactly.

    My doctor prescribed Fosamax, as did every other physician at the time, to keep my bones strong. He insisted I keep taking it even after I developed severe acid reflux. I finally switched to Actonel, which had other joint pain side effects. By the time I found research for side effects of these drugs on the web, I had a severe case of Barrett’s Disease. The drug of choice is Aciphex, which has terrible neurological side effects, so now I am forced to take Prilosec EVERY day (may cause reflux) to keep my acute gastritis under control.

    I am also taking aloe vera & probiotic acidophilus. Is there anything else natural that I can take to cut back on (the fat pill) Prilosec. It adds 20 lbs, which then causes more reflux!!

    I wish I had NEVER taken Fosamax to begin with. Now I research every drug prescribed, & weigh the risk factors.

    I think doctors should know all ramifications of the prescriptions they hand out. The resulting symptoms in withdrawal from these drugs is worse than any benefit the drug might have had initially, and worse than the initial complaint for which they were prescribed. I was prescribed Xanax for problems with early waking. I quit the drug only to find l now couldn’t sleep at all.

    More scary stuff from modern medicine. At some point in time I have taken protonix and celexa together, was in a trial using zometa to see if it could prevent the return of breast cancer in post menopausal women. A year and a half ago I had a short course of prednisone, low dose, and a few months later the scoliosis I already had, since childhood, worsened considerably. When I said something to the doctor, he said, oh prednisone will do that. Why not tell me before?

    As for menopausal symptoms, my symptoms got worse as I aged. I had extreme night sweats, hot flashes only a minute or two apart, and then someone recommended Change O Life by Natures Way. With the first dose I felt the world lift off my shoulders. The night sweats disappeared and the hot flashes became manageable with cold water. I took it for about four or five years, then tried decreasing it. That went well, so I discontinued it. However, at the time I started, it was very much a life saver.

    I just checked it at Swanson’s, it says it can be used to ease PMS also. A month’s supply is 7.29 and, for menopause, you would use it on a daily basis. I cannot speak to using it for PMS, tho if I had known about it, I surely would have tried!

    Chances are that ALL of the drugs listed above will deplete
    Vitamin B12 levels.

    It is possible other nutrients are also blocked from absorption.

    What in the WORLD did either of the drugs the doctor prescribed have to do with menopausal symptoms anyway???

    Better to go to a woman-savvy herbalist than to trust oneself to a doctor dependant on the pharmaceutical industry for answers.

    I’m sure The People’s Pharmacy information guide about menopause will provide some alternative ideas, and I’d also recommend Susun Weed’s book on menopause and the menopausal years as food for a lot of thought on both the subject and treatments.

    Actually I think you don’t need the additional drugs besides the bisphosphonates to have fractures (although they certainly can make things worse). So the bisphophonates work by preventing the clearing out of bone by inhibiting osteoclasts, which at first makes it look like you have more bone density. As time goes on (about 5 years) there is little room left for new bone to develope and bingo! your bone fractures. Why the makers of these products seem to not know this is a fabrication at best, pure deception most likely.

    Ellot in NJ – you are spot on! Do you get “Osteopenia” monthly newsletter by Kate Lindemann? Anyone who is concerned with their bones, should not we all be, should find her website or get her (not always) monthly newsletter. She is not health professional but older gracious woman, who has had health struggles and because her profession has been in literary research, who continually researches on all these issues that relate to our bones and then freely shares that research (which you can research to see if true). I have medical background and she is wonderful. She has so much information on weight bearing exercise, physiology and the effect of medications, and on and on.

    Years ago I read a book called “The Myth Of Osteoporosis.” It had a lot to say about this latest “disease” and the medications being pushed. Even though some of the side effects are bad, doctors love to get women on these drugs. They never recommend weight bearing exercise. Why is that?

    We had an uncle who used to say, “Farmers plow; surgeons cut.” Similarly, doctors prescribe. Many don’t have the training to coach patients in weight bearing exercise. Others who may have recommended exercise grew discouraged when some patients didn’t follow through. Someone who already has osteoporosis still benefits from exercise, but needs to approach it sensibly so as not to increase the risk of a fall leading to a fracture.

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