Increase in Vertebral Fracture Risk in Postmenopausal Women Using Omeprazole

Roux, Christian; Briot, Karine; Gossec, Laure; Kolta, Sami; Blenk, Tilo; Felsenberg, Dieter; Reid, David M.; Eastell, Richard; Glüer, Claus C.

doi:10.1007/s00223-008-9188-4

Cited by 108 publications

(87 citation statements)

References 44 publications

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“…38 Observational studies have yielded inconclusive results regarding the association between use of ASDs and fracture risk, with reported adjusted odds ratios (ORs) or relative risks (RRs) ranging widely, from 0.88 to 3.10. Some epidemiologic studies have found that PPI therapy is associated with an increased risk of hip fractures, 22,23,[39][40][41] whereas a nested case-control study did not fi nd any signifi cant association. 42 To our knowledge, no meta-analysis of such studies has been conducted.…”

Section: Introductionmentioning

confidence: 89%

See 1 more Smart Citation

Use of Acid-Suppressive Drugs and Risk of Fracture: A Meta-analysis of Observational Studies

Eom¹,

Park

Myung

et al. 2011

The Annals of Family Medicine

103

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PURPOSE Previous studies have reported inconsistent fi ndings regarding the association between the use of acid-suppressive drugs such as proton pump inhibitors (PPIs) and histamine 2 receptor antagonists (H 2 RAs) and fracture risk. We investigated this association using meta-analysis. METHODSWe searched MEDLINE (PubMed), EMBASE, and the Cochrane Library from inception through December 2010 using common key words. We included case-control, nested case-control, and cohort studies. Two evaluators independently reviewed and selected articles. We determined pooled effect estimates by using random-effects meta-analysis, because of heterogeneity.RESULTS Of 1,809 articles meeting our initial inclusion criteria, 5 case-control studies, 3 nested case-control studies, and 3 cohort studies were included in the fi nal analyses. The pooled odds ratio (OR) for fracture was 1.29 (95% confi dence interval [CI], 1.18-1.41) with use of PPIs and 1.10 (95% CI, 0.99-1.23) with use of H 2 RAs when compared with nonuse of the respective medications. Long-term use of PPIs increased the risk of any fracture (adjusted OR = 1.30; 95% CI, 1.15-1.48) and hip fracture risk (adjusted OR = 1.34; 95% CI, 1.09-1.66), whereas long-term H 2 RA use was not signifi cantly associated with fracture risk. CONCLUSIONSWe found possible evidence linking PPI use to an increased risk of fracture, but no association between H 2 RA use and fracture risk. Widespread use of PPIs with the potential risk of fracture is of great importance to public health. Clinicians should carefully consider their decision to prescribe PPIs for patients already having an elevated risk of fracture because of age or other factors.

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Section: Introductionmentioning

confidence: 89%

“…The remaining 11 studies were included in the fi nal analysis. 22,23,[39][40][41][42]49,[50][51][52][53] No abstract, not relevant content (4), commentaries (6), author replies (2), letter (2), review article (1), medical news and perspectives (1) Remaining articles (n = 18), full text review…”

Section: Characteristics Of the Included Studiesmentioning

confidence: 99%

Use of Acid-Suppressive Drugs and Risk of Fracture: A Meta-analysis of Observational Studies

Eom¹,

Park

Myung

et al. 2011

The Annals of Family Medicine

103

View full text Add to dashboard Cite

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“…The study reported that the risk of hip fracture was markedly increased among long-term users of high-dose PPI therapy. PPIs were recently identifi ed as an independent risk factor for osteoporotic fracture (14,(27)(28)(29)(30)(31). PPIs reportedly increase the risk of osteoporotic fracture by causing hypochlorhydria, reducing intestinal calcium absorption and subsequently inducing a negative calcium balance (26,30).…”

Section: Discussionmentioning

confidence: 99%

Effects of rabeprazole on bone metabolic disorders in a gastrectomized rat model

et al. 2016

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Abstract. Proton pump inhibitors (PPIs) are frequently prescribed to patients with gastroesophageal reflux disease; however, the number of bone fractures reportedly increased in these patients. Although PPIs have been shown to inhibit the bone resorption by osteoclasts, the effect of PPIs on skeletal metabolism remains controversial. The aim of the present study was to determine the effect of the PPI rabeprazole on skeletal metabolism using gastrectomized rats. Male Wistar rats were divided into four groups: i) Sham-surgery (n=15); ii) total gastrectomy (TG) control (n=20); iii) TG plus rabeprazole (n=20); and iv) TG plus the bisphosphonate minodronic acid (n=20). Twenty-two weeks after TG, the rats were sacrificed, and bone mineral density (BMD), bone strength and markers for bone metabolism were measured. Compared with the control group (50.0±8.1%), the TG-induced decrease in BMD was significantly ameliorated in the rabeprazole group (56.5±7.5%) and the minodronic acid group (59.0±6.0%). However, rabeprazole did not improve bone strength. In conclusion, rabeprazole does not appear to exacerbate bone metabolic disorders in gastrectomized rats, but rather ameliorates the TG-induced BMD decrease.

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“…35,36 Prospective studies have also shown increased risk of fracture with PPIs. 37,38 The effects of PPIs may differ between men and women and may depend on calcium intake. 38 Studies of less potent acid-reducing agents such as H 2 receptor antagonists have revealed conflicting results on fracture risk, so additional studies are needed to determine whether a relationship exists.…”

Section: Proton Pump Inhibitorsmentioning

confidence: 99%

Update on Medications With Adverse Skeletal Effects

Pitts

Kearns

2011

Mayo Clinic Proceedings

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Patients rely on their primary care physician to manage multiple, often chronic medical conditions that require prescription medications. Balancing the risk to benefit of treatments can be challenging and requires that the primary care physician stay abreast of new information regarding risks and benefits. The number of medications with reported adverse effects on skeletal health is expanding. This review focuses on medications recently added to the list of "bad to the bone" drugs and on recent advances in management of glucocorticoid-induced osteoporosis. A practical approach to assessing and managing the skeletal risks is outlined.Mayo Clin Proc. 2011;86(4):338-343 BMD = bone mineral density; GnRH = gonadotropin-releasing hormone; 5HTT = 5-hydroxytryptamine transporter; PPARγ = peroxisome proliferator-activated receptor gamma; PPI = proton pump inhibitor; SSRI = selective serotonin reuptake inhibitor; TCA = tricyclic antidepressant © 2011 Mayo Foundation for Medical Education and ResearchOn completion of this article, you should be able to (1) identify prescription medications associated with increased risk of fractures, (2) recognize the importance of assessing baseline fracture risk in patients initiating and continuing these medications, and (3) recognize the role of teriparatide in patients at high risk of fracture who must take glucocorticoids.

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Increase in Vertebral Fracture Risk in Postmenopausal Women Using Omeprazole

Cited by 108 publications

References 44 publications

Use of Acid-Suppressive Drugs and Risk of Fracture: A Meta-analysis of Observational Studies

Use of Acid-Suppressive Drugs and Risk of Fracture: A Meta-analysis of Observational Studies

Effects of rabeprazole on bone metabolic disorders in a gastrectomized rat model

Update on Medications With Adverse Skeletal Effects

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