- 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.
- 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).
- 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.
- Potential for residual confounding and confounding by indication.