PPIs are linked to higher pediatric fracture risk

  • Wang YH & al.
  • JAMA Pediatr
  • 16 Mar 2020

  • curated by Jenny Blair, MD
  • Clinical Essentials
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Takeaway

  • The use of proton pump inhibitors (PPIs) is associated with a small but significant elevation in fracture risk for children.

Why this matters

  • PPIs have been linked to possible fracture risk in adults, but few data have previously addressed this in children.
  • Most treatment guidelines for PPI use in children are based on expert opinion.
  • These drugs are being prescribed to children increasingly often. 

Key results

  • Mean age, 12.6 years; mean follow-up, 2.2 years.
  • PPI use vs nonuse, HRs (95% CIs):
    • Any first fracture: 1.11 (1.06-1.15).
    • Upper-limb fracture: 1.08 (1.03-1.13).
    • Lower-limb fracture: 1.19 (1.10-1.29).
    • Other fracture: 1.51 (1.16-1.97).
    • No association with head or spine fracture.
  • HRs rose with cumulative duration of PPI use:
    • ≤30 days: 1.08 (1.03-1.13). 
    • 31-364 days: 1.14 (1.09-1.20).
    • ≥365 days: 1.34 (1.13-1.58).

Study design

  • Nationwide register-based cohort study comparing Swedish children who began using PPIs with propensity-matched children who did not (n=231,866).
  • Outcome: first fracture.
  • Funding: Swedish Research Council, Frimurare Barnhuset Foundation.

Limitations

  • Potential for residual confounding and confounding by indication.