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Proton pump inhibitors, histamine H2 receptor antagonists, and other antacid medications and the risk of fracture.

Abstract

We studied the effect of proton pump inhibitors, histamine H(2) receptor antagonists, and other types of antacid drugs on fracture risk. All cases were subjects with any fracture sustained during the year 2000 (n = 124,655). For each case, three controls (n = 373,962) matched on age and gender were randomly drawn from the background population. The primary exposure variables were use of proton pump inhibitors, histamine H(2) antagonists, and other antacid drugs. Adjustments were made for several confounders, including diagnosis of an ulcer, nonsteroidal anti-inflammatory drug use, use of histamine H(1) antagonists, stomach resection, previous fracture, and use of corticosteroids. The effect of dose was examined by stratifying for cumulated dose (defined daily dose). Use of proton pump inhibitors was associated with an increase in fracture risk for use within the last year [odds ratio (OR) = 1.18, 95% confidence interval (CI) 1.12-1.43 for overall fracture risk; OR = 1.45, 95% CI 1.28-1.65 for hip fractures; and OR = 1.60, 95% CI 1.25-2.04 for spine fractures). Histamine H(2) antagonists were associated with a decreased fracture risk if they had been used within the last year (OR = 0.88, 95% CI 0.82-0.95 for any fracture, OR = 0.69, 95% CI 0.57-0.84 for hip fractures). Other antacids were not associated with overall fracture risk but were associated with hip and spine fractures. Proton pump inhibitors appeared to be associated with a limited increase in fracture risk, in contrast to histamine H( 2 ) antagonists, which seemed to be associated with a small decrease in fracture risk. In all cases, the changes in risk estimates were small and the clinical significance was limited.

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  • Authors+Show Affiliations

    ,

    The Osteoporosis Clinic, Aarhus Amtssygehus, Aarhus University Hospital, Tage Hansens Gade 2, DK-8000, Aarhus C, Denmark. p-vest@post4.tele.dk

    ,

    Source

    Calcified tissue international 79:2 2006 Aug pg 76-83

    MeSH

    Adrenal Cortex Hormones
    Adult
    Aged
    Antacids
    Anti-Inflammatory Agents
    Case-Control Studies
    Female
    Fractures, Bone
    Histamine H2 Antagonists
    Humans
    Male
    Middle Aged
    Proton Pump Inhibitors
    Registries
    Risk

    Pub Type(s)

    Journal Article
    Research Support, Non-U.S. Gov't

    Language

    eng

    PubMed ID

    16927047

    Citation

    Vestergaard, P, et al. "Proton Pump Inhibitors, Histamine H2 Receptor Antagonists, and Other Antacid Medications and the Risk of Fracture." Calcified Tissue International, vol. 79, no. 2, 2006, pp. 76-83.
    Vestergaard P, Rejnmark L, Mosekilde L. Proton pump inhibitors, histamine H2 receptor antagonists, and other antacid medications and the risk of fracture. Calcif Tissue Int. 2006;79(2):76-83.
    Vestergaard, P., Rejnmark, L., & Mosekilde, L. (2006). Proton pump inhibitors, histamine H2 receptor antagonists, and other antacid medications and the risk of fracture. Calcified Tissue International, 79(2), pp. 76-83.
    Vestergaard P, Rejnmark L, Mosekilde L. Proton Pump Inhibitors, Histamine H2 Receptor Antagonists, and Other Antacid Medications and the Risk of Fracture. Calcif Tissue Int. 2006;79(2):76-83. PubMed PMID: 16927047.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Proton pump inhibitors, histamine H2 receptor antagonists, and other antacid medications and the risk of fracture. AU - Vestergaard,P, AU - Rejnmark,L, AU - Mosekilde,L, Y1 - 2006/08/15/ PY - 2006/01/29/received PY - 2006/04/26/accepted PY - 2006/8/24/pubmed PY - 2006/12/9/medline PY - 2006/8/24/entrez SP - 76 EP - 83 JF - Calcified tissue international JO - Calcif. Tissue Int. VL - 79 IS - 2 N2 - We studied the effect of proton pump inhibitors, histamine H(2) receptor antagonists, and other types of antacid drugs on fracture risk. All cases were subjects with any fracture sustained during the year 2000 (n = 124,655). For each case, three controls (n = 373,962) matched on age and gender were randomly drawn from the background population. The primary exposure variables were use of proton pump inhibitors, histamine H(2) antagonists, and other antacid drugs. Adjustments were made for several confounders, including diagnosis of an ulcer, nonsteroidal anti-inflammatory drug use, use of histamine H(1) antagonists, stomach resection, previous fracture, and use of corticosteroids. The effect of dose was examined by stratifying for cumulated dose (defined daily dose). Use of proton pump inhibitors was associated with an increase in fracture risk for use within the last year [odds ratio (OR) = 1.18, 95% confidence interval (CI) 1.12-1.43 for overall fracture risk; OR = 1.45, 95% CI 1.28-1.65 for hip fractures; and OR = 1.60, 95% CI 1.25-2.04 for spine fractures). Histamine H(2) antagonists were associated with a decreased fracture risk if they had been used within the last year (OR = 0.88, 95% CI 0.82-0.95 for any fracture, OR = 0.69, 95% CI 0.57-0.84 for hip fractures). Other antacids were not associated with overall fracture risk but were associated with hip and spine fractures. Proton pump inhibitors appeared to be associated with a limited increase in fracture risk, in contrast to histamine H( 2 ) antagonists, which seemed to be associated with a small decrease in fracture risk. In all cases, the changes in risk estimates were small and the clinical significance was limited. SN - 0171-967X UR - https://www.unboundmedicine.com/medline/citation/16927047/Proton_pump_inhibitors_histamine_H2_receptor_antagonists_and_other_antacid_medications_and_the_risk_of_fracture_ L2 - https://dx.doi.org/10.1007/s00223-006-0021-7 DB - PRIME DP - Unbound Medicine ER -