Combinations of Drugs Linked To Bone Fractures, Such as Nexium and Opioids, Can Increase Risks Exponentially: Study

New research appears to confirm long-held suspicions of medical experts, indicating that many elderly patients who suffer bone breaks are taking multiple drugs at the same time that carry an increased risk of fractures.

In findings published this month in the medical journal JAMA Network Open, researchers from Dartmouth University suggest that many bone fractures among elderly individuals occur following use of a “cocktail” of different drugs that may weaken bones, rather than blaming the breaks on just one medication.

For some time, experts have suspected that many individuals are unknowingly compounding their risk of fractures, due to the wide array of fracture-associated drugs that are regularly prescribed to elderly individuals, especially amid an overall growth in drug prescriptions over the past few decades.

Researchers conducted a cohort study involving data on more than 2.6 million Medicare beneficiaries from 2004 through 2014, identifying 21 different medications that are “fracture-associated drugs” (FADs), including opioids, diuretics and proton pump inhibitors (PPIs); which include an entire class of widely used heartburn drugs, such as Nexium, Prilosec and Prevacid.

The findings indicate not only a large association between fractures and the use of multiple drugs, which was to be expected, but it also found that there is a compounding side effect linked to taking those drugs. According to the findings, taking just one drug linked to fracture risks doubled the risk of bone fractures. However, taking two nearly tripled the risks and taking three or more FADs quadrupled the risk.

The researchers found that the most commonly used fracture-associated drugs were opioids, which were used by 55% of the patients reviewed as part of the study. About 40% took diuretics, and 35% took drugs like Nexium and Prilosec. The combinations linked to the highest risks of fractures included opioids with other sedatives, opioids with diuretics, as well as opioids used with PPIs.

Researchers indicate that the findings could inform doctors about ways to better prescribe drugs to reduce fracture risks.

“Our findings suggested a need to update and refine our conceptual approach to identifying problematic drug regimens, moving past count and appropriateness in favor of nuanced considerations of overlapping risks and benefits,” they concluded. “The exploration of mechanisms through which FAD pairs confer excess risk or risk-mitigating effects could inform efforts aimed at minimizing harm.”

Heartburn Drug Bone Fracture Risks

The FDA forced the manufacturers of Nexium and all other proton pump inhibitor medications to update their warning labels in 2010, providing the first information to consumers and the medical community about the risk of fractures and bone problems.

That warning was updated by the FDA in 2011, indicating that the risk of broken bones from Nexium and other drugs of the class appears to be linked to high doses of the medication used over long periods of time.  Over-the-counter versions of the drug did not appear to be affected, according to federal drug regulators.

In addition to bone fracture concerns, in recent years a growing number of Nexium lawsuits, Prilosec lawsuits, Prevacid lawsuits and similar claims have been filed against the PPI drug makers, alleging that consumers have not been adequately warned about the potential side effects associated with long-term use of the drugs.

Complaints have been filed by individuals diagnosed with gastric cancer, acute kidney injury, chronic kidney disease and other injuries, indicating that they would not have continued long-term use if the risks had been disclosed.