Wednesday, December 27, 2006

Ostoporosis risk increased by celiac and heartburn medications: Is there a collision of increase risk?

Osteoporosis is increased by long-term use of acid blocker medications called proton pump inhibitors for chronic heartburn, a symptom commonly missed as a sign of celiac disease. So, not only doctors frequently unaware that osteoporosis is a common complication of undiagnosed and untreated celiac disease but are also likely aggravated the problem in many of these people by prescribing acid blocking medications for heartburn symptoms that are due to gluten.

Osteoporosis risk goes up with age. 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. I have however, noted increasing number of below 60 year old women and more men diagnosed with osteoporosis, almost none of whom have been screened for celiac disease or inflammatory bowel disease.

At least one study has documented that less than half of doctors are aware that osteoporosis is a manifestation of celiac disease. Heartburn is 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 gluten-free diet has been shown to diminish reflux symptoms and result in healing of esophagitis.

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.

This effect I have 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.

Celiac increases 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 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.

With this new study raising the concern about long-term use of acid blocking medications, especially the so-called proton pump inhibitors like nexium and prilosec, causing an increase risk of osteoporosis and the frequently unrecognized association of heartburn with undiagnosed celiac disease that also increases the risk.

You are now forewarned about blindly accepting a doctor’s offer to just write you a prescription for such medication without looking further into the possible causes of your heartburn as well as the risks of simply treating your symptom with a medication. This is especially important since the medication may actually worsen a known complication of an underlying undiagnosed problem that can be simply treated by diet decreasing your risk of osteoporosis. Subscribe to this blog to receive automatic updates of new posts offering information and insights from the Food Doc so that you are kept up to date
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