Omeprazole is a proton pump inhibitor (PPI), a medication that inhibits the production of stomach acid. Because stomach acid plays a role in calcium absorption, PPIs are known to raise the risk of osteoporosis, or thinning bones. If stomach acid is suppressed, calcium absorption is inhibited, and stomach acid production declines with age.
The first-line treatment for osteoporosis in the majority of postmenopausal women is oral bisphosphonates, such as alendronate. These slow down the rate at which old bone cells are reabsorbed, so strengthening bones.
However, if you have an oesophageal condition or acid reflux due to a hiatus hernia (when a portion of the stomach pushes through the diaphragm), these medications can irritate the esophagus even more.
Hormone replacement treatment (HRT) comes to mind. I recently wrote about this in response to a reader who inquired about using it to preserve cognitive function. It can help protect bones, but it is not a first-line treatment for osteoporosis, and its bone-related advantages are greatest when it is initiated shortly after menopause.
In addition to lifestyle modifications such as daily exercise, quitting smoking, and limiting alcohol consumption, there are further options.
Your physician may determine that you would benefit most from the care of an osteoporosis management expert.
One possibility is zoledronic acid, a kind of bisphosphonate administered annually by intravenous infusion. This method eliminates the possibility of esophagus-related negative effects.
Denosumab, a monoclonal antibody medication that blocks a receptor on cells involved in bone turnover, could be a second alternative. This injection is administered every six months and has been found to increase bone density and decrease fracture incidence.
Other potential treatments include selective estrogen receptor modulators such as raloxifene; teriparatide, a type of parathyroid hormone; calcitonin; and strontium, which protect the bones in various ways.
I believe that intravenous bisphosphonate may be the most likely provided treatment.
According to a study, women taking PPIs for an extended period should take a calcium supplement that does not require acid for absorption. Calcium citrate is optimal.
The good news is that PPIs do not interfere with the absorption of calcium from foods such as milk and cheese, so I would recommend incorporating these into your diet.
Your doctor was entirely correct in ordering an MRI, as it helps rule out neurological and vascular factors. You add in your longer letter that you were also checked for type 2 diabetes, as low blood sugar can cause confusion and severe thirst, which can cause dry lips. However, this was ruled out.
Your symptoms are uncommon, but I have one suggestion for you: a blockage of the superior vena cava.
This occurs when the superior vena cava, a major vein that returns deoxygenated blood from the top part of the body to the heart, is obstructed or under pressure, causing blood to pool in the upper body.
This results in symptoms such as face puffiness, vertigo, shortness of breath, and coughing.
Because lying down stimulates blood to pool more, the symptoms tend to intensify while the patient is supine. A chest X-ray or CT scan can assist with diagnosis confirmation. Pressure from swollen lymph nodes in the upper chest cavity is one of the potential explanations.
I recommend that you consult your physician immediately for additional evaluation.
While there has been a justifiable focus on the crisis in general practice, I would urge the new Health Secretary, Steve Barclay, to pay particular attention to the equally grave challenges in dentistry.
Approximately 90% of NHS clinics are currently unable to accept new customers, making it increasingly difficult to find a dentist. Aside from personnel problems, the contract for paying dentists is broken and there is inadequate funding.
Given the connections between oral illness and disorders such as heart disease, pneumonia, and type 2 diabetes, the ripple impact is extensive. The difficulty of accessing dental care is a ticking time bomb that will further damage the NHS.
