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Use of proton pump inhibitors is associated with fractures in young adults: a population-based study.
Osteoporos Int 2015; 26(10):2501-7OI

Abstract

Proton pump inhibitors (PPIs) are associated with risk for fracture in osteoporotic adults. In this population-based study, we found a significant association between PPIs and fracture in young adults, with evidence of a dose-response effect. Young adults who use PPIs should be cautioned regarding risk for fracture.

INTRODUCTION

Proton pump inhibitors (PPIs) are associated with fracture in adults with osteoporosis. Because PPI therapy may interfere with bone accrual and attainment of peak bone mineral density, we studied the association between use of PPIs and fracture in children and young adults.

METHODS

We conducted a population-based, case-control study nested within records from general medical practices from 1994 to 2013. Participants were 4-29 years old with ≥ 1 year of follow-up who lacked chronic conditions associated with use of long-term acid suppression. Cases of fracture were defined as the first incident fracture at any site. Using incidence density sampling, cases were matched with up to five controls by age, sex, medical practice, and start of follow-up. PPI exposure was defined as 180 or more cumulative doses of PPIs. Conditional logistic regression was used to estimate the odds ratio and confidence interval for use of PPIs and fracture.

RESULTS

We identified 124,799 cases and 605,643 controls. The adjusted odds ratio for the risk of fracture associated with PPI exposure was 1.13 (95% CI 0.92 to 1.39) among children aged < 18 years old and 1.39 (95% CI 1.26 to 1.53) among young adults aged 18-29 years old. In young adults but not children, we observed a dose-response effect with increased total exposure to PPIs (p for trend <0.001).

CONCLUSIONS

PPI use was associated with fracture in young adults, but overall evidence did not support a PPI-fracture relationship in children. Young adults who use PPIs should be cautioned regarding potentially increased risk for fracture, even if they lack traditional fracture risk factors.

Authors+Show Affiliations

Division of Digestive and Liver Diseases, Columbia University Medical Center, 630 West 168th Street, PH-7, New York, NY, 10032, USA. def2004@cumc.columbia.edu.Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA.Division of Nephrology, The Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA.Department of Pediatrics, The Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA.Departments of Medicine and Pediatrics, Stanford University School of Medicine, Stanford, CA, 94305, USA.Division of Digestive and Liver Diseases, Columbia University Medical Center, 630 West 168th Street, PH-7, New York, NY, 10032, USA.Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA. Division of Gastroenterology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA.

Pub Type(s)

Journal Article
Multicenter Study
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

25986385

Citation

Freedberg, D E., et al. "Use of Proton Pump Inhibitors Is Associated With Fractures in Young Adults: a Population-based Study." Osteoporosis International : a Journal Established as Result of Cooperation Between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA, vol. 26, no. 10, 2015, pp. 2501-7.
Freedberg DE, Haynes K, Denburg MR, et al. Use of proton pump inhibitors is associated with fractures in young adults: a population-based study. Osteoporos Int. 2015;26(10):2501-7.
Freedberg, D. E., Haynes, K., Denburg, M. R., Zemel, B. S., Leonard, M. B., Abrams, J. A., & Yang, Y. X. (2015). Use of proton pump inhibitors is associated with fractures in young adults: a population-based study. Osteoporosis International : a Journal Established as Result of Cooperation Between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA, 26(10), pp. 2501-7. doi:10.1007/s00198-015-3168-0.
Freedberg DE, et al. Use of Proton Pump Inhibitors Is Associated With Fractures in Young Adults: a Population-based Study. Osteoporos Int. 2015;26(10):2501-7. PubMed PMID: 25986385.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Use of proton pump inhibitors is associated with fractures in young adults: a population-based study. AU - Freedberg,D E, AU - Haynes,K, AU - Denburg,M R, AU - Zemel,B S, AU - Leonard,M B, AU - Abrams,J A, AU - Yang,Y-X, Y1 - 2015/05/19/ PY - 2015/03/02/received PY - 2015/05/06/accepted PY - 2015/5/20/entrez PY - 2015/5/20/pubmed PY - 2016/7/7/medline KW - Acid suppression medications KW - Bone mineral density KW - Fracture KW - Histamine-2 receptor antagonists KW - Osteoporosis KW - Outcomes research KW - Pediatrics KW - Pharmacoepidemiology KW - Proton pump inhibitors SP - 2501 EP - 7 JF - Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA JO - Osteoporos Int VL - 26 IS - 10 N2 - UNLABELLED: Proton pump inhibitors (PPIs) are associated with risk for fracture in osteoporotic adults. In this population-based study, we found a significant association between PPIs and fracture in young adults, with evidence of a dose-response effect. Young adults who use PPIs should be cautioned regarding risk for fracture. INTRODUCTION: Proton pump inhibitors (PPIs) are associated with fracture in adults with osteoporosis. Because PPI therapy may interfere with bone accrual and attainment of peak bone mineral density, we studied the association between use of PPIs and fracture in children and young adults. METHODS: We conducted a population-based, case-control study nested within records from general medical practices from 1994 to 2013. Participants were 4-29 years old with ≥ 1 year of follow-up who lacked chronic conditions associated with use of long-term acid suppression. Cases of fracture were defined as the first incident fracture at any site. Using incidence density sampling, cases were matched with up to five controls by age, sex, medical practice, and start of follow-up. PPI exposure was defined as 180 or more cumulative doses of PPIs. Conditional logistic regression was used to estimate the odds ratio and confidence interval for use of PPIs and fracture. RESULTS: We identified 124,799 cases and 605,643 controls. The adjusted odds ratio for the risk of fracture associated with PPI exposure was 1.13 (95% CI 0.92 to 1.39) among children aged < 18 years old and 1.39 (95% CI 1.26 to 1.53) among young adults aged 18-29 years old. In young adults but not children, we observed a dose-response effect with increased total exposure to PPIs (p for trend <0.001). CONCLUSIONS: PPI use was associated with fracture in young adults, but overall evidence did not support a PPI-fracture relationship in children. Young adults who use PPIs should be cautioned regarding potentially increased risk for fracture, even if they lack traditional fracture risk factors. SN - 1433-2965 UR - https://www.unboundmedicine.com/medline/citation/25986385/Use_of_proton_pump_inhibitors_is_associated_with_fractures_in_young_adults:_a_population_based_study_ L2 - https://dx.doi.org/10.1007/s00198-015-3168-0 DB - PRIME DP - Unbound Medicine ER -