PPIs up risk for hip fracture in large meta-analysis

  • Poly TN & al.
  • Osteoporos Int
  • 12 Dec 2018

  • curated by Miriam Davis, PhD
  • Clinical Essentials
Access to the full content of this site is available only to registered healthcare professionals. Access to the full content of this site is available only to registered healthcare professionals.

Takeaway

  • A large meta-analysis finds that use of proton pump inhibitors (PPIs) may increase the risk for hip fracture by 20%.
  • Higher, sustained doses are associated with the greatest risk.

Why this matters

  • Largest meta-analysis to date confirms and extends an earlier meta-analysis.
  • Findings suggest that clinicians should be cautious about long-term PPI therapy in patients with already higher risk for hip fracture.

Study design

  • Meta-analysis of 24 observational studies (15 case-control; 9 cohort) involving 2,103,800 participants, of whom 319,568 had hip fractures.
  • Selected studies (must be n≥500 with ≥1 year follow-up) were obtained from MEDLINE, EMBASE, Google Scholar, and Web of Science.
  • Funding: Ministry of Education, Taiwan; Health and Welfare surcharge of tobacco grants.

Key results

  • Use of PPIs (vs nonuse) was associated with a higher risk for hip fracture (risk ratio [RR], 1.20; P<.0001>
  • The association increased with the highest doses:
    • Low dose: RR, 1.17 (P=.002).
    • Medium dose: RR, 1.29 (P<.0001>
    • High dose: RR, 1.30 (P<.0001>
  • The association increased with longer duration of use:
    • ≥3 years of use: RR, 1.24 (P<.0001>
  • No association was found for another gastric medication, H2 receptor antagonist.

Limitations

  • Observational designs.
  • No randomized controlled studies.
  • Not enough information on sex, age, smoking status, alcohol use.

Please confirm your acceptance

To gain full access to GPnotebook please confirm:

By submitting here you confirm that you have accepted Terms of Use and Privacy Policy of GPnotebook.

Submit