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Antacids linked to higher fracture risk in children

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New research suggests that infants prescribed antacids for acid reflux have an increased risk of fractures during childhood.

Acid reflux, also known as gastro-esophageal reflux (GER), is often treated with drugs such as proton pump inhibitors (PPIs) and histamine H2-receptor antagonists (H2-blockers), which decrease the production of stomach acids. These types of medications have been linked with increased bone fractures in adults, but until now there has been a lack of research into whether they might have the same effect in children, the American Academy of Pediatrics explained.

Researchers examined the records of 874,447 healthy children born within the US Military Healthcare System from 2001 to 2013 who received care within the system for at least two years. Approximately 10% of the children were prescribed antacids in the first year of life, including H2-blockers such as ranitidine (Zantac) and famotidine (Pepsid) as well as PPIs such as omeprazole (Prilosec) and pantoprazole (Protonix). A small percentage of the children were prescribed both.

Analysis of the records revealed that children who used PPIs had a 22% increased likelihood of fracture, while children who used both PPIs and H2-blockers had a 31% increased likelihood of fracture. Use of H2-blockers was not associated with an immediate increase in factures, but there was an increased likelihood of fracture at a later time.

The researchers also found that the number of bone fractures children experienced increased with the number of days they took these medications. Additionally, there was a higher fracture risk among children who first began using antacid medications under six months old.

There was no increased fracture risk in children who started using antacids after the age of two years, compared with children who were not prescribed antacids in the first five years of life.

Based on the findings, US Air Force Captain Dr Laura Malchodi, lead author of the study and a paediatrics resident at Walter Reed National Military Medical Center, advised that use of antacid medications in infants should be weighed carefully against possible fracture.

“With many antacids easily available over-the-counter for adults, these medications may seem benign,” Dr Malchodi said. “However, our study adds to a growing body of evidence suggesting antacid medications are not safe for children, especially very young children, and should only be prescribed to treat confirmed serious cases of more severe symptomatic gastroesophageal reflux disease (GERD), and for the shortest length of time needed.”

An abstract of the study was presented at the recent Pediatric Academic Societies Meeting in San Francisco.