Bethesda, MD—Suffering a bone fracture later in childhood is a greater risk for infants prescribed antacids to manage reflux, compared to those who never took the drugs, according to a new study.
The research was presented at the 2017 Pediatric Academic Societies Meeting in San Francisco.
Background information in the study notes that gastroesophageal reflux is commonly treated with proton pump inhibitors (PPIs) and histamine H2-receptor antagonists (H2-blockers), which decrease stomach acid production. While the medications have been tied to increased bone fractures in adults, up to this point, little research had looked at whether children could suffer from the same effect.
To remedy that, researchers from the Walter Reed National Military Medical Center and colleagues reviewed the records of 874,447 healthy children born within the Military Healthcare System (MHS) from 2001 to 2013 and who received care within the system for at least 2 years.
Overall, about 10% of the youngsters were prescribed antacids in the first year of life, including H2-blockers such as ranitidine and famotidine, as well as PPIs such as omeprazole and pantoprazole. A small percentage was prescribed both, study authors point out.
Results indicate that children prescribed PPIs had a 22% increased likelihood of fracture, while children who used both PPIs and H2-blockers had a 31% heightened risk. Use of H2-blockers alone was not associated with an immediate increase in factures, the study found,
but the risk grew over time.
Duration of treatment also had an effect: The researchers note that the number of bone fractures children experienced increased with the number of days they took the medications.
Furthermore, the younger a child first began using antacid medications, the higher the likelihood of breaking a bone, with the highest fracture risk among those who initiated antacid medications under 6 months old.
On the other hand, children who started using antacids after age 2 years did not have increased fractures when compared with children who were not prescribed antacids in the first 5 years of life, according to the results.
The lead author, Air Force Capt. Laura Malchodi, MD, a pediatrics resident at Walter Reed National Military Medical Center, suggested that the decision to prescribe antacid medications to infants should be carefully considered.
“With many antacids easily available over-the-counter for adults, these medications may seem benign,” 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, and for the shortest length of time needed.”
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