Long-Term Antacid Use: Osteoporosis and Nutrient Deficiency Risks
Chronic, high-dose antacid use (especially proton pump inhibitors [PPIs] and aluminum-containing antacids) carries risks:
- Calcium malabsorption: Acid-dependent calcium carbonate/solubility reduced → osteoporosis/fracture risk
- Vitamin B12 deficiency: Acid needed to cleave B12 from food protein
- Magnesium deficiency: PPIs impair active transport (hypomagnesemia)
- Iron deficiency: Reduced ferric→ferrous conversion
- Infections: C. difficile, pneumonia (gastric acid barrier lost)
- Kidney disease: Associated with chronic PPI use
- Dementia risk: Observational link; mechanism unclear
Management
- Use lowest effective dose; shortest duration
- Step down to H2 blocker or on-demand therapy
- Monitor calcium, B12, Mg, Fe if long-term
- Lifestyle: weight loss, head-of-bed elevation, avoid triggers
- Discuss with clinician before stopping (rebound hyperacidity)
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