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Proton pump inhibitors and bone fractures?
Am J Gastroenterol 2009; 104 Suppl 2:S21-6AJ

Abstract

The objective of this study was to critically assess studies regarding proton pump inhibitors (PPIs) and fractures. A MEDLINE search was conducted to identify relevant articles. Three case-control studies assessed fractures and PPI use. A study of all subjects with fracture in Denmark in 2000 revealed adjusted OR=1.18 (1.12-1.43) for PPI use within the last year (hip fracture OR=1.45,1.28-1.65); no dose-response relationship was identified. A study of hip fractures in UK patients > or =50 years found adjusted OR=1.44 (1.30-1.59) for >1 year of PPIs; duration and average daily dose were significantly associated with fracture risk: adjusted OR for >1.75 times average daily dose for >1 year was 2.65 (1.80-3.90). A study of vertebral, wrist, and hip fractures in Manitoba patients > or =50 years found adjusted OR=0.99 (0.90-1.11) for > or =1 year of continuous PPI; association became significant > or =7 years (OR=1.92, 1.16-3.18). Consistency of some positive results in all studies, the dose and/or duration response in two studies, the possibility that acid inhibition may decrease calcium absorption, and association with histamine(2)-receptor antagonists in some studies support a causal association. The low magnitude of the association (ORs<2), lack of dose-response in one study, lack of association with histamine(2)-receptor antagonists in one study, lack of experimental evidence documenting a mechanism, and inability to assess potential confounding factors limit statements regarding causality. As with all medications, PPIs should be used for appropriate indications and not in higher doses or longer durations than necessary to achieve the desired outcomes.

Authors+Show Affiliations

Keck School of Medicine, University of Southern California, Los Angeles, California, USA. llaine@usc.edu

Pub Type(s)

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

Language

eng

PubMed ID

19262543

Citation

Laine, Loren. "Proton Pump Inhibitors and Bone Fractures?" The American Journal of Gastroenterology, vol. 104 Suppl 2, 2009, pp. S21-6.
Laine L. Proton pump inhibitors and bone fractures? Am J Gastroenterol. 2009;104 Suppl 2:S21-6.
Laine, L. (2009). Proton pump inhibitors and bone fractures? The American Journal of Gastroenterology, 104 Suppl 2, pp. S21-6. doi:10.1038/ajg.2009.48.
Laine L. Proton Pump Inhibitors and Bone Fractures. Am J Gastroenterol. 2009;104 Suppl 2:S21-6. PubMed PMID: 19262543.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Proton pump inhibitors and bone fractures? A1 - Laine,Loren, PY - 2009/3/6/entrez PY - 2009/3/6/pubmed PY - 2009/3/28/medline SP - S21 EP - 6 JF - The American journal of gastroenterology JO - Am. J. Gastroenterol. VL - 104 Suppl 2 N2 - The objective of this study was to critically assess studies regarding proton pump inhibitors (PPIs) and fractures. A MEDLINE search was conducted to identify relevant articles. Three case-control studies assessed fractures and PPI use. A study of all subjects with fracture in Denmark in 2000 revealed adjusted OR=1.18 (1.12-1.43) for PPI use within the last year (hip fracture OR=1.45,1.28-1.65); no dose-response relationship was identified. A study of hip fractures in UK patients > or =50 years found adjusted OR=1.44 (1.30-1.59) for >1 year of PPIs; duration and average daily dose were significantly associated with fracture risk: adjusted OR for >1.75 times average daily dose for >1 year was 2.65 (1.80-3.90). A study of vertebral, wrist, and hip fractures in Manitoba patients > or =50 years found adjusted OR=0.99 (0.90-1.11) for > or =1 year of continuous PPI; association became significant > or =7 years (OR=1.92, 1.16-3.18). Consistency of some positive results in all studies, the dose and/or duration response in two studies, the possibility that acid inhibition may decrease calcium absorption, and association with histamine(2)-receptor antagonists in some studies support a causal association. The low magnitude of the association (ORs<2), lack of dose-response in one study, lack of association with histamine(2)-receptor antagonists in one study, lack of experimental evidence documenting a mechanism, and inability to assess potential confounding factors limit statements regarding causality. As with all medications, PPIs should be used for appropriate indications and not in higher doses or longer durations than necessary to achieve the desired outcomes. SN - 1572-0241 UR - https://www.unboundmedicine.com/medline/citation/19262543/Proton_pump_inhibitors_and_bone_fractures L2 - http://Insights.ovid.com/pubmed?pmid=19262543 DB - PRIME DP - Unbound Medicine ER -