Tags

Type your tag names separated by a space and hit enter

Use of acid-suppressive drugs and risk of fracture: a meta-analysis of observational studies.

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.

Links

  • PMC Free PDF
  • PMC Free Full Text
  • FREE Publisher Full Text
  • Authors+Show Affiliations

    ,

    Department of Family Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.

    , , ,

    Source

    MeSH

    Anti-Ulcer Agents
    Cimetidine
    Confidence Intervals
    Fractures, Bone
    Gastric Acid
    Gastroesophageal Reflux
    Histamine H2 Antagonists
    Humans
    Odds Ratio
    Proton Pump Inhibitors
    Risk Assessment
    Risk Factors

    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 -