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Use of proton pump inhibitors [stomach acid reducing drugs] and risk of osteoporosis-related fractures – Source: Canadian Medical Association Journal – Aug 2008

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[Note: To read the full text of this article free, click here. Proton pump inhibitors – designed to inhibit stomach acid production – are among the most-prescribed drugs in the world. On the other hand, hypochlorhydria – insufficient stomach acid – prevents protein digestion and absorption of nutrients including the calcium and vitamin B12 needed to avoid leaching of calcium from bones and to replace old bone with new.]

Background: The use of proton pump inhibitors has been associated with an increased risk of hip fracture. We sought to further explore the relation between:

• Duration of exposure to proton pump inhibitors

• And osteoporosis-related fractures.

Methods: We used administrative claims data to identify patients with a fracture of the hip, vertebra, or wrist between April 1996 and March 2004. Cases were each matched with 3 controls based on age, sex and comorbidities. We calculated adjusted odds ratios (OR) for the risk of hip fracture and all osteoporosis-related fractures for durations of proton pump inhibitor exposure ranging from 1 or more years to more than 7 years.

Results: We matched 15,792 cases of osteoporosis-related fractures with 47,289 controls.

• We did not detect a significant association between the overall risk of an osteoporotic fracture and the use of proton pump inhibitors for durations of 6 years or less.

• However, exposure of 7 or more years was associated with increased risk of an osteoporosis-related fracture (adjusted OR 1.92, 95% confidence interval [CI] 1.16-3.18, p = 0.011). [Note: an odds ratio of 1.0 would mean there is no difference in risk. An OR of 1.92 means the risk of an osteoporosis-related vertebra, wrist, or other fracture is 92% greater among the group taking proton pump inhibitors.]

• We also found an increased risk of hip fracture after 5 or more years of exposure (adjusted OR 1.62, 95% CI 1.02-2.58, p = 0.04) [62% greater risk of hip fracture].

• With even higher risk after 7 or more years exposure (adjusted OR 4.55, 95% CI 1.68-12.29, p = 0.002) [355% greater risk of hip fracture].

Interpretation:

• Use of proton pump inhibitors for 7 or more years is associated with a significantly increased risk of an osteoporosis-related fracture.

• There is an increased risk of hip fracture after 5 or more years exposure.

Further study is required to determine the clinical importance of this finding and to determine the value of osteoprotective medications for patients with long-term use of proton pump inhibitors.

Source: Canadian Medical Association Journal – Aug 2008, 12;179(4):306-7. PMID: 18695179, by Targownik LE, Lix LM, Metge CJ, Prior HJ, Leung S, Leslie WD. Department of Gastroenterology, Division of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada. [E-mail: bleslie@sbgh.mb.ca]

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