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Proton-pump inhibitors and risk of fractures: an update meta-analysis.

Abstract

To identify the relationship between proton-pump inhibitors (PPIs) and the risk of fracture, we conducted an update meta-analysis of observational studies. Results showed that PPI use was associated with a modestly increased risk of hip, spine, and any-site fracture.

INTRODUCTION

Many studies have investigated the association of proton-pump inhibitors (PPIs) with fracture risk, but the results have been inconsistent. To evaluate this question, we performed a meta-analysis of relevant observational studies.

METHODS

A systematic literature search up to February 2015 was performed in PubMed. We combined relative risks (RRs) for fractures using random-effects models and conducted subgroup and stratified analyses.

RESULTS

Eighteen studies involving a total of 244,109 fracture cases were included in this meta-analysis. Pooled analysis showed that PPI use could moderately increase the risk of hip fracture [RR = 1.26, 95 % confidence intervals (CIs) 1.16–1.36]. There was statistically significant heterogeneity among studies (p < 0.001; I 2 = 71.9 %). After limiting to cohort studies, there was also a moderate increase in hip fracture risk without evidence of study heterogeneity. Pooling revealed that short-term use (<1 year) and longer use (>1 year) were similarly associated with increased risk of hip fracture. Furthermore, a moderately increased risk of spine (RR = 1.58, 95 % CI 1.38–1.82) and any-site fracture (RR = 1.33, 95 % CI 1.15–1.54) was also found among PPI users.

CONCLUSION

In this update meta-analysis of observational studies, PPI use modestly increased the risk of hip, spine, and any-site fracture, but no evidence of duration effect in subgroup analysis.

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    MeSH

    Hip Fractures
    Humans
    Observational Studies as Topic
    Osteoporotic Fractures
    Proton Pump Inhibitors
    Risk Assessment
    Spinal Fractures

    Pub Type(s)

    Journal Article
    Meta-Analysis

    Language

    eng

    PubMed ID

    26462494

    Citation

    Zhou, B, et al. "Proton-pump Inhibitors and Risk of Fractures: an Update Meta-analysis." Osteoporosis International : a Journal Established as Result of Cooperation Between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA, vol. 27, no. 1, 2016, pp. 339-47.
    Zhou B, Huang Y, Li H, et al. Proton-pump inhibitors and risk of fractures: an update meta-analysis. Osteoporos Int. 2016;27(1):339-47.
    Zhou, B., Huang, Y., Li, H., Sun, W., & Liu, J. (2016). Proton-pump inhibitors and risk of fractures: an update meta-analysis. Osteoporosis International : a Journal Established as Result of Cooperation Between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA, 27(1), pp. 339-47.
    Zhou B, et al. Proton-pump Inhibitors and Risk of Fractures: an Update Meta-analysis. Osteoporos Int. 2016;27(1):339-47. PubMed PMID: 26462494.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Proton-pump inhibitors and risk of fractures: an update meta-analysis. AU - Zhou,B, AU - Huang,Y, AU - Li,H, AU - Sun,W, AU - Liu,J, PY - 2015/09/11/received PY - 2015/10/01/accepted PY - 2015/10/15/entrez PY - 2015/10/16/pubmed PY - 2016/11/1/medline SP - 339 EP - 47 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 - 27 IS - 1 N2 - UNLABELLED: To identify the relationship between proton-pump inhibitors (PPIs) and the risk of fracture, we conducted an update meta-analysis of observational studies. Results showed that PPI use was associated with a modestly increased risk of hip, spine, and any-site fracture. INTRODUCTION: Many studies have investigated the association of proton-pump inhibitors (PPIs) with fracture risk, but the results have been inconsistent. To evaluate this question, we performed a meta-analysis of relevant observational studies. METHODS: A systematic literature search up to February 2015 was performed in PubMed. We combined relative risks (RRs) for fractures using random-effects models and conducted subgroup and stratified analyses. RESULTS: Eighteen studies involving a total of 244,109 fracture cases were included in this meta-analysis. Pooled analysis showed that PPI use could moderately increase the risk of hip fracture [RR = 1.26, 95 % confidence intervals (CIs) 1.16–1.36]. There was statistically significant heterogeneity among studies (p < 0.001; I 2 = 71.9 %). After limiting to cohort studies, there was also a moderate increase in hip fracture risk without evidence of study heterogeneity. Pooling revealed that short-term use (<1 year) and longer use (>1 year) were similarly associated with increased risk of hip fracture. Furthermore, a moderately increased risk of spine (RR = 1.58, 95 % CI 1.38–1.82) and any-site fracture (RR = 1.33, 95 % CI 1.15–1.54) was also found among PPI users. CONCLUSION: In this update meta-analysis of observational studies, PPI use modestly increased the risk of hip, spine, and any-site fracture, but no evidence of duration effect in subgroup analysis. SN - 1433-2965 UR - https://www.unboundmedicine.com/medline/citation/26462494/Proton_pump_inhibitors_and_risk_of_fractures:_an_update_meta_analysis_ L2 - https://dx.doi.org/10.1007/s00198-015-3365-x DB - PRIME DP - Unbound Medicine ER -