Infants prescribed antacids for reflux have increased risk of bone fractures
SAN FRANCISCO – New research being presented at the 2017 Pediatric Academic Societies
Meeting found infants prescribed antacids to manage acid reflux, or spitting up, under
age 1 had more bone fractures later in childhood.
An abstract of the study, “Early Antacid Exposure Increases Fracture Risk in Young
Children,” will be presented on Sunday, May 7, at the Moscone West Convention Center
in San Francisco.
Acid reflux, also known as gastro-esophageal reflux (GER), is frequently treated with
drugs such as proton pump inhibitors (PPIs) and histamine H2-receptor antagonists
(H2-blockers) that decrease production of stomach acids. These types of medications
have been linked with increased bone fractures in adults, but there has been a lack
of research into whether they might have the same effect in children.
Researchers examined the records of 874,447 healthy children born within the Military
Healthcare System (MHS) from 2001 to 2013 who received care within the system for
at least two years. They found 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 was prescribed both.
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, the study
found, but there was an increased likelihood of fracture with time.
In addition, the number of bone fractures children experienced increased with the
number of days they took these medications. The younger a child first began using
antacid medications, the higher the fracture risk. Those started on antacid medications
earlier -- under 6 months old -- had the most increased fracture risk. Children who
started using antacids after age 2 years did not have increased fractures as compared
to children who were not prescribed antacids in the first five years of life.
Use of antacid medications in infants should be weighed carefully against possible
fracture, said U.S. Air Force Capt. Laura Malchodi, M.D., lead author of the study
and a pediatrics resident at Walter Reed National Military Medical Center.
“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.”
GER is a common condition that affects roughly 40% to 65%t of all infants. It usually
begins at approximately 2 to 3 weeks of life and peaks between 4 to 5 months. In most
babies, GER disappears by about 1 year of age as the upper digestive tract functionally
matures. The American Academy of Pediatrics believes it is important for all pediatric
health care providers to be able to properly identify and treat children with reflux
symptoms, and to distinguish GER from more worrisome disorders so as to avoid unnecessary
The Pediatric Academic Societies (PAS) Meeting brings together thousands of individuals
united by a common mission: to improve child health and well-being worldwide. This
international gathering includes pediatric researchers, leaders in academic pediatrics,
experts in child health, and practitioners. The PAS Meeting is produced through a
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child advocacy: Academic Pediatric Association, American Academy of Pediatrics, American
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