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Proton pump inhibitors and risk of fractures: a meta-analysis of 11 international studies.

Abstract

BACKGROUND

Concerns have been raised about the risk of fractures with acid-suppressive medications, such as proton pump inhibitors and histamine(2)-receptor antagonists.

METHODS

This meta-analysis evaluated the association between proton pump inhibitor or histamine(2)-receptor antagonist use and fractures. We performed a systematic search of published literature (1970 to October 10, 2010) in MEDLINE, EMBASE, and other sources. Ten publications reporting 11 studies were considered eligible for analysis.

RESULTS

All studies were observational case-control or cohort studies and primarily evaluated older adults. The summary effect estimate for risk of hip fracture increased modestly among individuals taking proton pump inhibitors (relative risk [RR] 1.30, 95% confidence interval [CI], 1.19-1.43). There also was an increase in spine (RR 1.56, 95% CI, 1.31-1.85) and any-site fractures (RR 1.16, 95% CI, 1.04-1.30) among proton pump inhibitor users. These findings were similar in both men and women and after stratification by duration of use. In contrast, histamine(2)-receptor antagonist use was not significantly associated with increased risk of hip fracture (RR 1.12, 95% CI, 0.97-1.30).

CONCLUSION

In this meta-analysis of observational studies, proton pump inhibitors modestly increased the risk of hip, spine, and any-site fractures, whereas histamine(2)-receptor antagonists were not associated with fracture risk. The possibility of residual confounding cannot be excluded. Further skeletal evaluation should be considered for patients who are taking proton pump inhibitors and also at risk for osteoporotic fracture.

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  • Authors+Show Affiliations

    ,

    Endocrine Unit, Massachusetts General Hospital, Boston, USA. ewyu@partners.org

    , ,

    Source

    The American journal of medicine 124:6 2011 Jun pg 519-26

    MeSH

    Aged
    Anti-Ulcer Agents
    Bone Density
    Canada
    Europe
    Female
    Gastrointestinal Agents
    Hip Fractures
    Histamine H2 Antagonists
    Humans
    Male
    Middle Aged
    Odds Ratio
    Osteoporotic Fractures
    Proton Pump Inhibitors
    Research Design
    Risk Factors
    Spinal Fractures
    United States

    Pub Type(s)

    Journal Article
    Meta-Analysis
    Research Support, N.I.H., Extramural

    Language

    eng

    PubMed ID

    21605729

    Citation

    Yu, Elaine W., et al. "Proton Pump Inhibitors and Risk of Fractures: a Meta-analysis of 11 International Studies." The American Journal of Medicine, vol. 124, no. 6, 2011, pp. 519-26.
    Yu EW, Bauer SR, Bain PA, et al. Proton pump inhibitors and risk of fractures: a meta-analysis of 11 international studies. Am J Med. 2011;124(6):519-26.
    Yu, E. W., Bauer, S. R., Bain, P. A., & Bauer, D. C. (2011). Proton pump inhibitors and risk of fractures: a meta-analysis of 11 international studies. The American Journal of Medicine, 124(6), pp. 519-26. doi:10.1016/j.amjmed.2011.01.007.
    Yu EW, et al. Proton Pump Inhibitors and Risk of Fractures: a Meta-analysis of 11 International Studies. Am J Med. 2011;124(6):519-26. PubMed PMID: 21605729.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Proton pump inhibitors and risk of fractures: a meta-analysis of 11 international studies. AU - Yu,Elaine W, AU - Bauer,Scott R, AU - Bain,Paul A, AU - Bauer,Douglas C, PY - 2010/12/10/received PY - 2011/01/11/revised PY - 2011/01/14/accepted PY - 2011/5/25/entrez PY - 2011/5/25/pubmed PY - 2011/7/19/medline SP - 519 EP - 26 JF - The American journal of medicine JO - Am. J. Med. VL - 124 IS - 6 N2 - BACKGROUND: Concerns have been raised about the risk of fractures with acid-suppressive medications, such as proton pump inhibitors and histamine(2)-receptor antagonists. METHODS: This meta-analysis evaluated the association between proton pump inhibitor or histamine(2)-receptor antagonist use and fractures. We performed a systematic search of published literature (1970 to October 10, 2010) in MEDLINE, EMBASE, and other sources. Ten publications reporting 11 studies were considered eligible for analysis. RESULTS: All studies were observational case-control or cohort studies and primarily evaluated older adults. The summary effect estimate for risk of hip fracture increased modestly among individuals taking proton pump inhibitors (relative risk [RR] 1.30, 95% confidence interval [CI], 1.19-1.43). There also was an increase in spine (RR 1.56, 95% CI, 1.31-1.85) and any-site fractures (RR 1.16, 95% CI, 1.04-1.30) among proton pump inhibitor users. These findings were similar in both men and women and after stratification by duration of use. In contrast, histamine(2)-receptor antagonist use was not significantly associated with increased risk of hip fracture (RR 1.12, 95% CI, 0.97-1.30). CONCLUSION: In this meta-analysis of observational studies, proton pump inhibitors modestly increased the risk of hip, spine, and any-site fractures, whereas histamine(2)-receptor antagonists were not associated with fracture risk. The possibility of residual confounding cannot be excluded. Further skeletal evaluation should be considered for patients who are taking proton pump inhibitors and also at risk for osteoporotic fracture. SN - 1555-7162 UR - https://www.unboundmedicine.com/medline/citation/21605729/full_citation L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002-9343(11)00164-1 DB - PRIME DP - Unbound Medicine ER -