Study highlights fracture risk with PPI drugs
Patients receiving proton pump inhibitor drugs at high doses have a greater risk of hip fracture, according to the authors of a recent study
(JAMA 2006;296:2947).
Investigators in the US analysed records from 13,556 cases of hip fracture
and 135,386 controls from the UK General Practice Research Database and
found that the long-term use of high-dose PPIs is associated with an
increased risk of hip fracture (adjusted odds ratio 2.65, 95 per cent
confidence interval 1.8–3.9; P<0.001). The strength of the association
increased with each year of PPI treatment.
It is suggested that calcium malabsorption secondary to gastric acid
suppression might explain the increased risk. On the other hand, the
authors say that limited experimental data suggest the osteoclastic proton
transport system may be inhibited by PPIs, potentially reducing bone
resorption.
They say: “It is possible that the potentially protective effect
of osteoclastic proton pump inhibition may have cancelled out some of
the negative effects of gastric acid suppression by PPIs, especially
at regular doses. … However, with high-dose PPI therapy, the effect
of gastric acid suppression dominated.” |
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