Proton pump inhibitors therapy and risk of hip fracture

Ye, Xiaofei; Li, Hong; Wu, Chih Chiang; Qin, Yingyi; Zang, Jiajie; Gao, Qing-Bin; Zhang, Xinji; He, Jia

doi:10.1097/meg.0b013e328348a56a

Cited by 63 publications

(37 citation statements)

References 34 publications

(60 reference statements)

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“…Second, the relationship between different classes of possible comparator drug classes and fractures is complex and no clear class of agents could be identified that would serve as an ideal analogue of a placebo controlled randomised trial to treat VMS. H2A/PPIs were selected as the comparator agent because studies have shown that H2As have a trivial or no association with risk of fractures,30–32 while PPIs are associated with a slightly increased risk of fractures 30 33 34. These considerations would tend to drive the differences in fracture risks between the SSRI and our comparator cohort towards the null, provided SSRIs elevate fracture risk.…”

Section: Discussionmentioning

confidence: 99%

SSRI use and risk of fractures among perimenopausal women without mental disorders

et al. 2015

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Background Selective serotonin reuptake inhibitors (SSRIs) were recently approved by the FDA to treat vasomotor symptoms associated with menopause. No prior study has directly examined whether fracture risk is increased among perimenopausal women who initiate SSRIs or among a population of women without mental disorders more generally. Methods Female patients without mental illness, aged 40-64 years, who initiated SSRIs were compared with a cohort who initiated H2 antagonists (H2As) or protonpump inhibitors (PPIs) in 1998-2010, using data from a claims database. Standardised mortality ratio weighting was applied using the propensity score odds of treatment to adapt the distribution of characteristics among patients starting H2A/PPIs to the distribution among SSRI initiators. Poisson regression estimated risk differences and Cox proportional hazards regression the RR of fractures among new users of SSRIs versus H2A/ PPIs. Primary analyses allowed for a 6-month lag period (ie, exposure begins 6 months after initiation) to account for a hypothesised delay in the onset of any clinically meaningful effect of SSRIs on bone mineral density. Results Fracture rates were higher among the 137 031 SSRI initiators compared with the 236 294 H2A/PPI initiators, with HRs (SSRI vs H2A/PPI) over 1, 2 and 5 years of 1.76 (95% CI 1.33 to 2.32), 1.73 (95% CI 1.33 to 2.24) and 1.67 (95% CI 1.30 to 2.14), respectively. Conclusions SSRIs appear to increase fracture risk among middle-aged women without psychiatric disorders, an effect sustained over time, suggesting that shorter duration of treatment may decrease fracture risk. Future efforts should examine whether this association pertains at lower doses.

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Section: Discussionmentioning

confidence: 99%

SSRI use and risk of fractures among perimenopausal women without mental disorders

et al. 2015

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“…However, the studies have been limited by significant heterogeneity, and when studies were adjusted to take into account other risk factors for fracture, the use of PPI was not considered to be the cause. Histamine receptor antagonists do not appear to be associated with the risk of fractures [28,29,30].…”

Section: Discussionmentioning

confidence: 99%

Acute Effects Of Oral Calcium Carbonate With And Without The Addition Of Omeprazole And Fiber Enriched Milk On Serum Calcium Concentrations In Postmenopausal Women

Oliveira¹,

Silveira

Melo³

et al. 2017

int arch med

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Introduction: In recent years, some studies have shown an increase in cardiovascular risk due to the use of calcium supplements in excess of the recommended doses. One hypothesis is that some calcium supplements lead to a more pronounced elevation of serum calcium concentrations. Objectives:The aim of this study was to evaluate the serum calcium responses after ingestion of calcium carbonate, with and without the prior use of omeprazole, and after ingestion of soluble fiber enriched milk (SFM). Method:Five postmenopausal women were evaluated in three phases. For each phase, the serum calcium responses were determined at 0h (baseline), 1h, 2h, 3h and 4h. After ingestion of 1200mg of calcium, both for the patients who received the calcium carbonate and for those who received SFM. Results:The rise in serum calcium observed after ingestion of calcium carbonate with a calcium peak of 0.56 mg/dl (p=0.032), and it was higher when compared to SFM 0.26 mg/dl (p=0.284). There was no significant elevation of serum calcium after ingestion of SFM. The calcium responses were negative after the administration of omeprazole in comparison with the use of calcium carbonate and SFM, reaching 7.06mg/dl vs 9.04mg/dl vs 9.12mg/dl at 0h, 5.30mg/ dl vs 9. 32mg/dl vs 9.00mg/dl at 1hr, 5.52mg/dl vs 9.48mg/dl vs 9.32mg/dl at 2hr, 5.18mg/dl vs 9.48mg/dl vs 9.34mg/dl at, respectively, p<0.001.

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“…Second, function of osteoclasts may be inhibited by PPIs, decreasing bone resorption and influencing bone remodelling. These notions are the base for the concerns that PPIs impair bone health, increasing bone fractures, particularly in those with high-dose therapy and/or long-term treatment 42. It is important to note that most studies have been performed in adult patients with risk factors for osteoporosis and bone fractures, and that results are not consistent.…”

Section: Toxicity Profiles Of Ppi In Childrenmentioning

confidence: 99%

Toxicity of long-term use of proton pump inhibitors in children

Bruyne

Itô²

2017

Arch Dis Child

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Proton pump inhibitor (PPI) use is becoming increasingly common. Although the toxicity profiles of PPIs are not well understood particularly in children, PPIs have been associated with increased risks of gastrointestinal and respiratory tract infection, vitamin B deficiency, hypomagnesaemia, bone fractures, and rebound hyperacidity after discontinuation. Prescribers should take into account that PPI uses pose toxicity risks, which remain to be fully characterised in infants and children.

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Proton pump inhibitors therapy and risk of hip fracture

Abstract: These results indicate that PPIs therapy might have the potential risk of hip fracture. Different effects on hip fracture in the subgroup analysis do not support a causal relationship between PPIs and hip fracture. Whether the risk exists warrants further investigation.

Cited by 63 publications

References 34 publications

SSRI use and risk of fractures among perimenopausal women without mental disorders

SSRI use and risk of fractures among perimenopausal women without mental disorders

Acute Effects Of Oral Calcium Carbonate With And Without The Addition Of Omeprazole And Fiber Enriched Milk On Serum Calcium Concentrations In Postmenopausal Women

Toxicity of long-term use of proton pump inhibitors in children

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