Proton pump inhibitors linked to fracture risk

Proton pump inhibitors (PPIs) are associated with a 29% increased risk of fracture, including a 31% increased risk of hip fracture and a 54% increased risk of vertebral fracture, according to a study published in the May/June 2011 issue of Annals of Family Medicine.

To investigate the association between the use of acid-suppressive drugs such as PPIs and histamine 2-receptor antagonists (H2RAs) and fracture risk, investigators searched MEDLINE (PubMed), EMBASE, and the Cochrane Library from beginning through December 2010, for case-control, nested case-control, and cohort studies.

The authors included 11 studies published between 1997 and 2011 in their meta-analysis: 5 case-control studies, 3 nested case-control studies, and 3 cohort studies. The authors found a moderate increase in the risk of fracture with PPI use compared with non-use; they found no association between the use of H2RAs and fracture. Long-term use of PPIs was associated with an increased risk of any fracture (adjusted OR=1.30; 95% CI, 1.15–1.48) and with hip fracture risk (adjusted OR=1.34; 95% CI, 1.09–1.66). Long-term H2RA use was not significantly associated with fracture risk. The results suggest that H2RAs and PPIs may have different effects on bone metabolism.

"Widespread use of PPIs with the potential risk of fracture is of great importance to public health. Clinicians should carefully consider their decision to prescribe PPIs for patients already having an elevated risk of fracture because of age or other factors,” the authors wrote. “It is not necessary to treat patients to the point of an achlorhydric state to resolve acid reflux symptoms, so we recommend that drug doses be chosen thoughtfully with consideration of what is necessary to achieve desired therapeutic goals.”