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Use of acid-suppressive drugs and risk of fracture: a meta-analysis of observational studies.
Ann Fam Med 2011 May-Jun; 9(3):257-67AF

Abstract

PURPOSE

Previous studies have reported inconsistent findings regarding the association between the use of acid-suppressive drugs such as proton pump inhibitors (PPIs) and histamine 2 receptor antagonists (H(2)RAs) and fracture risk. We investigated this association using meta-analysis.

METHODS

We searched MEDLINE (PubMed), EMBASE, and the Cochrane Library from inception through December 2010 using common key words. We included case-control, nested case-control, and cohort studies. Two evaluators independently reviewed and selected articles. We determined pooled effect estimates by using random-effects meta-analysis, because of heterogeneity.

RESULTS

Of 1,809 articles meeting our initial inclusion criteria, 5 case-control studies, 3 nested case-control studies, and 3 cohort studies were included in the final analyses. The pooled odds ratio (OR) for fracture was 1.29 (95% confidence interval [CI], 1.18-1.41) with use of PPIs and 1.10 (95% CI, 0.99-1.23) with use of H(2)RAs when compared with nonuse of the respective medications. Long-term use of PPIs increased the risk of any fracture (adjusted OR = 1.30; 95% CI, 1.15-1.48) and hip fracture risk (adjusted OR = 1.34; 95% CI, 1.09-1.66), whereas long-term H(2)RA use was not significantly associated with fracture risk.

CONCLUSIONS

We found possible evidence linking PPI use to an increased risk of fracture, but no association between H(2)RA use and fracture risk. 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.

Authors+Show Affiliations

Department of Family Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

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

Language

eng

PubMed ID

21555754

Citation

Eom, Chun-Sick, et al. "Use of Acid-suppressive Drugs and Risk of Fracture: a Meta-analysis of Observational Studies." Annals of Family Medicine, vol. 9, no. 3, 2011, pp. 257-67.
Eom CS, Park SM, Myung SK, et al. Use of acid-suppressive drugs and risk of fracture: a meta-analysis of observational studies. Ann Fam Med. 2011;9(3):257-67.
Eom, C. S., Park, S. M., Myung, S. K., Yun, J. M., & Ahn, J. S. (2011). Use of acid-suppressive drugs and risk of fracture: a meta-analysis of observational studies. Annals of Family Medicine, 9(3), pp. 257-67. doi:10.1370/afm.1243.
Eom CS, et al. Use of Acid-suppressive Drugs and Risk of Fracture: a Meta-analysis of Observational Studies. Ann Fam Med. 2011;9(3):257-67. PubMed PMID: 21555754.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Use of acid-suppressive drugs and risk of fracture: a meta-analysis of observational studies. AU - Eom,Chun-Sick, AU - Park,Sang Min, AU - Myung,Seung-Kwon, AU - Yun,Jae Moon, AU - Ahn,Jeong-Soo, PY - 2011/5/11/entrez PY - 2011/5/11/pubmed PY - 2011/9/9/medline SP - 257 EP - 67 JF - Annals of family medicine JO - Ann Fam Med VL - 9 IS - 3 N2 - PURPOSE: Previous studies have reported inconsistent findings regarding the association between the use of acid-suppressive drugs such as proton pump inhibitors (PPIs) and histamine 2 receptor antagonists (H(2)RAs) and fracture risk. We investigated this association using meta-analysis. METHODS: We searched MEDLINE (PubMed), EMBASE, and the Cochrane Library from inception through December 2010 using common key words. We included case-control, nested case-control, and cohort studies. Two evaluators independently reviewed and selected articles. We determined pooled effect estimates by using random-effects meta-analysis, because of heterogeneity. RESULTS: Of 1,809 articles meeting our initial inclusion criteria, 5 case-control studies, 3 nested case-control studies, and 3 cohort studies were included in the final analyses. The pooled odds ratio (OR) for fracture was 1.29 (95% confidence interval [CI], 1.18-1.41) with use of PPIs and 1.10 (95% CI, 0.99-1.23) with use of H(2)RAs when compared with nonuse of the respective medications. Long-term use of PPIs increased the risk of any fracture (adjusted OR = 1.30; 95% CI, 1.15-1.48) and hip fracture risk (adjusted OR = 1.34; 95% CI, 1.09-1.66), whereas long-term H(2)RA use was not significantly associated with fracture risk. CONCLUSIONS: We found possible evidence linking PPI use to an increased risk of fracture, but no association between H(2)RA use and fracture risk. 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. SN - 1544-1717 UR - https://www.unboundmedicine.com/medline/citation/21555754/Use_of_acid_suppressive_drugs_and_risk_of_fracture:_a_meta_analysis_of_observational_studies_ L2 - http://www.annfammed.org/cgi/pmidlookup?view=long&pmid=21555754 DB - PRIME DP - Unbound Medicine ER -