Patients who use proton pump inhibitors for 7 or more years to treat reflux, peptic ulcers and other conditions are at greater risk of osteoporosis-related fractures, according to this large observational study of 15,792 patients published in CMAJ.
There is specifically an increased risk of hip fracture after 5 years of continuous exposure and an increased risk of any fracture after 7 years continuous exposure. Short-term exposure did not appear to increase risk of fractures.
Proton pump inhibitors — a class of drugs commonly prescribed to control and prevent symptoms and complications of peptic ulcer disease and GERD (reflux) — are widely used by patients for many years.
The study looked at people aged 50 and older who had hip, spinal, or wrist fractures and were matched by a control group with no history of hip, spinal or wrist fractures.
The use of proton pump inhibitors has increased in recent years and use is often of indefinite duration.
"These factors may promote the long-term use of proton pump inhibitors, leaving patients at increased risk of osteoporosis-related fractures," write Dr. Laura Targownik and coauthors.
In a related commentary, Drs. Brent Richards and David Goltzman comment that three large administrative database studies have found proton pump inhibitors increase fracture risk. They caution that both the physician and patient should together weigh the risks and benefits of the long-term use of these drugs.
- Laura E. Targownik MD MSHS, Lisa M. Lix PhD, Colleen J. Metge PhD, Heather J. Prior MSc, Stella Leung MSc, William D. Leslie MD. Use of proton pump inhibitors and risk of osteoporosis-related fractures. CMAJ, 2008; 179 (4) DOI: 10.1503/cmaj.071330
- J. Brent Richards, MD and David Goltzman, MD. Proton pump inhibitors: balancing the benefits and potential fracture risks. CMAJ, 2008; 179: 306-307 DOI: 10.150/cmaj.080873
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