Proton pump inhibitor use and the risk of fractures among an older adult cohort

Harding, Barbara N; Weiss, Noel S.; Walker, Rod; Larson, Eric B.; Dublin, Sascha

doi:10.1002/pds.4406

Cited by 23 publications

(21 citation statements)

References 31 publications

(64 reference statements)

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“…2 Second, previous research has suggested that no significant association can be detected between proton pump inhibitors therapy and fracture risk in older adults. 4 Ozen et al's and our studies further confirm that even in patients with rheumatoid arthritis, such an association still does not exist. Third, I agree with Sugiyama's comments published in the Annals of the Rheumatic Diseases reporting that no conclusive evidence supports a cause-effect relationship between proton pump inhibitors therapy and fracture risk, regardless of the population studied.…”

supporting

confidence: 84%

Association between proton pump inhibitors therapy and fracture risk in patients with rheumatoid arthritis

Lai

Kuo²,

Liao

2019

Ann Rheum Dis

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supporting

confidence: 84%

Association between proton pump inhibitors therapy and fracture risk in patients with rheumatoid arthritis

Lai

Kuo²,

Liao

2019

Ann Rheum Dis

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“…Fracture risk in the general population using PPIs, such as children, young adults, men, elderly, and postmenopausal women, was explored in several studies [30,31,32,33,34,35,36,37,38,39,40,41,42]. In the case-control study of Freedberg et al involving children (4–17 years; n = 87,071; 69.8% were cases) and young adults (18–29 years; n = 37,728; 30.2% were cases) in the United States (follow-up period: five years), a positive relationship between fracture risk and PPI exposure in young adults was found, with a body mass index (BMI)-adjusted odds ratio (aOR) of 1.39 (95% confidence interval (CI): 1.26–1.53) [41].…”

Section: The Relationship Between Ppis and Fracture Riskmentioning

confidence: 99%

Proton Pump Inhibitors and Fracture Risk: A Review of Current Evidence and Mechanisms Involved

Thong

Soelaiman

Chin

2019

IJERPH

104

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The number of patients with gastroesophageal problems taking proton pump inhibitors (PPIs) is increasing. Several studies suggested a possible association between PPIs and fracture risk, especially hip fractures, but the relationship remains contentious. This review aimed to investigate the longitudinal studies published in the last five years on the relationship between PPIs and fracture risk. The mechanism underlying this relationship was also explored. Overall, PPIs were positively associated with elevated fracture risk in multiple studies (n = 14), although some studies reported no significant relationship (n = 4). Increased gastrin production and hypochlorhydria are the two main mechanisms that affect bone remodeling, mineral absorption, and muscle strength, contributing to increased fracture risk among PPI users. As a conclusion, there is a potential relationship between PPIs and fracture risks. Therefore, patients on long-term PPI treatment should pay attention to bone health status and consider prophylaxis to decrease fracture risk.

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“…Moreover, use of PPIs may also increase risk of falls [ 291 , 292 , 293 ]. These associations, however, have not been confirmed in a number of longitudinal studies and reviews [ 259 , 280 , 294 , 295 , 296 , 297 , 298 , 299 , 300 , 301 , 302 , 303 , 304 , 305 , 306 , 307 , 308 , 309 ]; even a modest reduction in fracture risk with PPI use has been reported [ 307 , 310 ]. Some researchers who are not supporting the association of PPI therapy with BMD recognize, nevertheless, that in PPI users the risk of fractures and falls could be higher [ 311 , 312 ] as the unadjusted HR was significantly elevated (1.36, 95% CI 1.19–1.55).…”

Section: Hpi-induced Upper Gut Diseases and Osteoporotic Fracturesmentioning

confidence: 99%

Helicobacter pylori Related Diseases and Osteoporotic Fractures (Narrative Review)

Fisher

Smith

2020

JCM

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Osteoporosis (OP) and osteoporotic fractures (OFs) are common multifactorial and heterogenic disorders of increasing incidence. Helicobacter pylori (H.p.) colonizes the stomach approximately in half of the world’s population, causes gastroduodenal diseases and is prevalent in numerous extra-digestive diseases known to be associated with OP/OF. The studies regarding relationship between H.p. infection (HPI) and OP/OFs are inconsistent. The current review summarizes the relevant literature on the potential role of HPI in OP, falls and OFs and highlights the reasons for controversies in the publications. In the first section, after a brief overview of HPI biological features, we analyze the studies evaluating the association of HPI and bone status. The second part includes data on the prevalence of OP/OFs in HPI-induced gastroduodenal diseases (peptic ulcer, chronic/atrophic gastritis and cancer) and the effects of acid-suppressive drugs. In the next section, we discuss the possible contribution of HPI-associated extra-digestive diseases and medications to OP/OF, focusing on conditions affecting both bone homeostasis and predisposing to falls. In the last section, we describe clinical implications of accumulated data on HPI as a co-factor of OP/OF and present a feasible five-step algorithm for OP/OF risk assessment and management in regard to HPI, emphasizing the importance of an integrative (but differentiated) holistic approach. Increased awareness about the consequences of HPI linked to OP/OF can aid early detection and management. Further research on the HPI–OP/OF relationship is needed to close current knowledge gaps and improve clinical management of both OP/OF and HPI-related disorders.

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Proton pump inhibitor use and the risk of fractures among an older adult cohort

Abstract: No association was observed between PPI use and fracture risk among older adults.

Cited by 23 publications

References 31 publications

Association between proton pump inhibitors therapy and fracture risk in patients with rheumatoid arthritis

Association between proton pump inhibitors therapy and fracture risk in patients with rheumatoid arthritis

Proton Pump Inhibitors and Fracture Risk: A Review of Current Evidence and Mechanisms Involved

Helicobacter pylori Related Diseases and Osteoporotic Fractures (Narrative Review)

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