Osteoporosis may be increased by acid reflux medications: Osteoporosis is increased by long-term use of acid blocker medications called proton pump inhibitors (PPI’s), like nexium, prilosec, and prevacid according to a new study. These PPI medications consistently are at the top of the list of most commonly prescribed drugs. Prilosec OTC is also available without a prescription. When heartburn, the primary symptom of acid reflux, is chronic doctors usually prescribe PPI’s like nexium.
Heartburn is a common unrecognized symptom of celiac disease:
Most doctors are unaware that heartburn is a common symptom of undiagnosed celiac disease. Most are also unaware that osteoporosis is a common complication of this disorder. As a result, medications that may cause or worsen osteoporosis are being given to or taken by people who have heartburn due to unrecognized CD. The result is that the misdiagnosis of the root cause of the problem leads to treatment that may also be causing or worsening osteoporosis.
Osteoporosis, though it increases with age, occurs earlier in bowel diseases:
The prevalence is less than 15% at age 50 but increases to almost 30% at age 60, 50% at age 70 and 70% at age 80. As a practicing gastroenterologist I have noted an increasing number of below 60-year-old women and many more men who have been diagnosed with osteoporosis who have never been screened for celiac disease or inflammatory bowel disease, both intestinal conditions commonly associated with an increase risk of osteoporosis.
Few doctors are aware that osteoporosis and heartburn are associated with celiac:
One study has highlighted the unawareness of primary care doctors that osteoporosis is associated with celiac disease. A large survey documented that less than half of doctors are aware that osteoporosis is a manifestation of celiac disease. Heartburn is also a common symptom also not commonly recognized by doctors as a manifestation of celiac disease. Gluten ingestion can impair gastric emptying resulting in more gastro-esophageal reflux. Initiation of a gluten-free diet has been shown to diminish reflux symptoms and result in the healing of esophagitis.
Reflux symptoms respond to a gluten-free diet:
Several patients I have evaluated for reflux symptoms, particularly when these symptoms were poorly controlled or the patient was considering surgery rather than take daily medications, were found to have celiac disease or non-celiac gluten sensitivity. In my experience, reflux symptoms frequently dramatically improve on a gluten free diet.
The positive effect of a gluten-free diet in relieving heartburn is not limited to celiac disease:
The beneficial effect of a gluten-free diet has been observed not only in celiac disease patients but also in those not meeting strict diagnostic criteria for CD. Prior to starting a gluten-free diet I took a daily proton pump inhibitor myself. After a GFD, I occasionally experience heartburn when I drink too much coffee or combine coffee, alcohol and chocolate in the same meal. In my opinion, everyone with significant heartburn or a diagnosis of reflux disease should be screened for gluten sensitivity and/or consider a trial of GFD.
How much does celiac disease increase the risk of osteoporosis?
How much celiac disease increases osteoporosis is debated. Studies have shown from small increases (1.5-1.8 times) to much larger (3-5 times) increases of osteoporosis in CD. Such increased risk has prompted for calls for screening all people with celiac disease for osteoporosis and all people with osteoporosis for celiac disease.
Increased risk of osteoporosis raises concern about long-term use of acid blocking medication:
With this new study raising the concern about long-term use of acid blocking medications causing an increase risk of osteoporosis and the frequently unrecognized association of heartburn with undiagnosed celiac disease the use of these medications without excluding CD and considering this side effect is dangerous. Do not blindly accept a doctor’s offer to write you a prescription for acid blocker medications without looking further into the possible causes of your heartburn as well as the risks of simply treating your symptom with a medication that may actually be worsening the complication risks of an underlying undiagnosed problem that can be simply treated by diet.
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