Reflux and bones

Just last week I published an article on gastroesophageal reflux (often abbreviated “GERD”). I wrote “All of these medications for GERD are really quite safe, which may be one reason why so many physicians use them indiscriminately for children who probably don’t even have reflux disease.”

Well, I think I missed the boat on this one. A new Canadian study in adults has shown that long-term use of acid-blocking medications can lead to decreased bone mineralization, presumably by interfering with calcium absorption in the gut. It’s difficult to know how “long term” use has to be to lead to problems, but we do know that children need to be able to absorb proportionally more calcium than adults to grow good bones. I was unable to find any studies looking for this effect in children, but there’s no reason to think that children won’t be affected by these medications in a similar way.

GERD medications, then, should still be considered safe for short-term use, probably on the order of a few months. For longer-term use, patients and doctors should think critically about whether the medications really need to be continued. If they do, parents need to ensure that the child is getting enough calcium, vitamin D, and exercise. If a child really has to stay on these medications very long term, for a few years or more, than I would do a bone mineral density study to see if calcium absorption is adequate.

This story reinforces an important lesson: all medications have side effects, and none should be considered “completely safe.” In fact, you can bet that any medicinal product that promises to be completely safe probably has no biologic activity at all. If a medicine, herb, or any alternative-medicine intervention has a genuine positive benefit, there is going to be a potential for side effects that needs to be kept in mind.

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