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Proton-pump Inhibitors and Bone Damage

Posted by Quintal on August 3, 2007, at 23:31:14

I was struck down with terrible abdominal pain a few weeks ago so I went to my GP after a week of agony, suspecting gallstones. But after a brief examination it was apparent my gallbladder was fit as a fiddle. The dear lady, no doubt suspecting mischief on my part, was skeptical, but prescribed a months supply of the proton-pump inhibitor lansoprazole anyway (30mg in the morning) with instructions to make another appointment if the pain returned after the course was complete. The idea being to switch off the stomach acid and allow the ulcer to heal over for a month before switching the acid back on again.

Some people, such as my dad, take these drugs long term though and there is evidence of 'increased risk of hip fracture' (I'm assuming that's a polite way of saying they cause osteoporosis) in people taking them for a year or more.
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Long-term Proton Pump Inhibitor Therapy and Risk of Hip Fracture

Yu-Xiao Yang, MD, MSCE; James D. Lewis, MD, MSCE; Solomon Epstein, MD; David C. Metz, MD

JAMA. 2006;296:2947-2953.

Context Proton pump inhibitors (PPIs) may interfere with calcium absorption through induction of hypochlorhydria but they also may reduce bone resorption through inhibition of osteoclastic vacuolar proton pumps.

Objective To determine the association between PPI therapy and risk of hip fracture.

Design, Setting, and Patients A nested case-control study was conducted using the General Practice Research Database (1987-2003), which contains information on patients in the United Kingdom. The study cohort consisted of users of PPI therapy and nonusers of acid suppression drugs who were older than 50 years. Cases included all patients with an incident hip fracture. Controls were selected using incidence density sampling, matched for sex, index date, year of birth, and both calendar period and duration of up-to-standard follow-up before the index date. For comparison purposes, a similar nested case-control analysis for histamine 2 receptor antagonists was performed.

Main Outcome Measure The risk of hip fractures associated with PPI use.

Results There were 13 556 hip fracture cases and 135 386 controls. The adjusted odds ratio (AOR) for hip fracture associated with more than 1 year of PPI therapy was 1.44 (95% confidence interval [CI], 1.30-1.59). The risk of hip fracture was significantly increased among patients prescribed long-term high-dose PPIs (AOR, 2.65; 95% CI, 1.80-3.90; P<.001). The strength of the association increased with increasing duration of PPI therapy (AOR for 1 year, 1.22 [95% CI, 1.15-1.30]; 2 years, 1.41 [95% CI, 1.28-1.56]; 3 years, 1.54 [95% CI, 1.37-1.73]; and 4 years, 1.59 [95% CI, 1.39-1.80]; P<.001 for all comparisons).

Conclusion Long-term PPI therapy, particularly at high doses, is associated with an increased risk of hip fracture.


Author Affiliations: Division of Gastroenterology (Drs Yang, Lewis, and Metz), Center for Clinical Epidemiology and Biostatistics (Drs Yang and Lewis), Department of Biostatistics and Epidemiology (Drs Yang and Lewis), and Division of Endocrinology (Dr Epstein), University of Pennsylvania School of Medicine, Philadelphia; and Department of Medicine, Doylestown Hospital Research Center, Doylestown, Pa (Dr Epstein).
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Q


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poster:Quintal thread:773849
URL: http://www.dr-bob.org/babble/20070730/msgs/773849.html