Proton Pump Inhibitor Complications

Studies link PPIs to increased risk of bacterial infection, bone fracture.
The CBS Evening News (5/10, story 6, Couric) reported on proton pump inhibitors (PPIs), which are "some very popular drugs used to treat acid reflux and ulcers." They are "sold under brand names like Nexium, Prilosec and Prevacid," and generate "$13.5 billion in sales."
In fact, in 2009, approximately 119 million PPI prescriptions were written in the US, making the medicines part of the third-largest selling class of drugs, the Wall Street Journal (5/11, Dooren) reports. Some physicians have raised concerns about overprescribing, however. CNN (5/10, Gardner) reported on its website that "the risks" of taking PPIs "may outweigh the benefits for people with less serious conditions, experts say." What's more, they "can have rare but serious side effects, including an increased risk of bacterial infection and bone fracture, according to several new studies in the Archives of Internal Medicine."
During one trial, researchers at the University of Washington "looked at 161,806 postmenopausal women who didn't have any history of hip fracture and were enrolled in the Women's Health Initiative, a 15-year research program," Bloomberg News (5/10, Ostrow) reported. "Over eight years of the study, there were 21,247 bone fractures." Even though "women who took the drugs were no more likely to break their hips than women who didn't take the drugs," the Boston Globe (5/10, Cooney) "White Coat Notes" blog reported that "they did have a 47 percent increased risk of spine fractures, a 26 percent increased risk of forearm or wrist fractures, and a 25 percent increased risk of other fractures."
Meanwhile, Dr. Michael Howell, of the Beth Israel Deaconess Medical Center, and colleagues "analyzed data on more than 100,000 patients discharged from the hospital over a five-year period," HealthDay (5/10, Goodwin) reported. They "found that taking a proton pump inhibitor each day increased the chances of a C. difficile infection by 74 percent," and "patients who took proton pump inhibitors longer than that had more than double the chance. That translates to about one additional case of C. difficile for every 533 people taking proton pump inhibitors."
Along similar lines, MedPage Today (5/10, Bankhead) reported that a study conducted by Amy Linsky, MD, of Boston Medical Center, revealed that "PPI use was associated with a 42% increase in the risk of recurrent C. difficile infection, with the greatest risk among patients older than 80 and in patients treated with antibiotics that were not targeted to the bacterium." Meanwhile, a paper written by Taiwanese scientists indicated that "high-dose PPI therapy proved to be no more effective than lower doses for controlling bleeding ulcers," while Harvard data revealed that "introduction of a standardized guideline for prescribing practices reduced inpatient use of PPIs, but only among patients who were not on PPIs at admission."
Indeed, Los Angeles Times (5/11, Maugh) reports, the "risks are relatively small, but the drugs are so widely used that large numbers of people are affected, wrote Dr. Mitchell H. Katz of the San Francisco Department of Public Health in an editorial accompanying the reports."