As the standard treatment for the impressively named problem Gastroesophageal Reflux Disease (GERD), Nexium (also sold as Esomeprazole) succeeds by reducing the amount of acid produced by your body’s proton pump. With less acid in the stomach, the risk of it leaking out of the stomach when you sit or lie down is reduced. As a result, the symptoms of heartburn are reduced in severity and your esophagus can begin the slow process of healing. The longer term use of this drug has two consequences. The first is that your stomach takes longer to process the food and pass it through into the colon. The second is a reduction in the amount of calcium absorbed by the body. This has two specific effects: it produces stiffness in the muscles and it makes the bones more fragile.

In 2019, Yu-Xiao Yang published a cohort study in the Journal of the American Medical Association warning of an increased risk of hip fractures and bad teeth. The study focused on people aged 50 and above who had been using one of the proton pump inhibitors for at least twelve months. The results were startling. The risk of fractures was 2.5 times higher for people using Nexium for more than one year than for people not using one of the proton pump inhibitors. The risk was greater for men than women. Because women are aware of the risk of osteoporosis following the menopause, they routinely take a calcium supplement at this age. Unfortunately men are not similarly at risk and so have not developed a culture of taking additional calcium. The rate of hip fractures among men was therefore unusually high.

So if you fall into this age group and it appears likely you will be taking Nexium for a considerable period of time you should sit down with your regular physician to discuss how you are going to keep the risks within acceptable limits. There are two basic calcium supplements: calcium citrate and calcium carbonate. The first problem to consider is the amount of calcium you need to add to your diet. There’s actually a finite amount your body can absorb. This depends on your body weight and general state of health. As a general rule, you should not take more than 500mg a day unless your doctors has specifically approved it. If you are already taking calcium in foods such as milk products including yoghurt, you must reduce the intake of pills. Calcium citrate is the easier for the body to absorb. Calcium carbonate requires a reasonable amount of stomach acid to support the absorption. This means you should always take this form together with food to stimulate the body to produce enough acid. If your doctor has been passively renewing prescriptions for Nexium, take the initiative and discuss how to keep strong teeth and avoid your bones growing fragile. This is particularly important if you are unsteady on your feet and at risk of falls.