Proton pump inhibitors’ use and risk of hip fracture: a systematic review and meta-analysis

Abstract

In the last decade, epidemiological studies presented inconsistent findings concerning the proton pump inhibitors (PPI) use and the risk of hip fracture. So, this systematic review and meta-analysis were performed with the aim to quantify the risk of hip fracture associated with PPI use. PubMed and Cochrane Central databases were searched from inception to January 2018. The quality of included studies in meta-analysis was assessed using Newcastle-Ottawa scale. Primary outcome of this study was to assess the risk of hip fracture among PPI user. Secondary outcomes include subgroup analysis based on study design, study quality, duration of PPI use, calcium intake, and geographical region. Sensitivity analysis was also performed. Review Manager (RevMan) was used to perform statistical analysis. This meta-analysis was based on seventeen studies. Pooled risk ratio showed a statistically significant association between PPI use and hip fracture risk (RR 1.26 [95% CI 1.17-1.35], p < 0.00001). Subgroup analysis, based on the study design, showed a highly significant association between PPI use and risk of hip fracture (p < 0.0001). The risk of hip fracture persisted even when stratified by calcium adjustment and the duration of PPI use (p < 0.0001). This meta-analysis suggests that PPI user have a 26% increased risk of hip fracture as compared to non-PPI user. Physicians should take caution in prescribing PPI to patients who are at increased risk of hip fracture.

Warfarin use increases bleeding risk in hemodialysis patients with atrial fibrillation: A meta‐analysis of cohort studies

“…The quality of included studies was judged based on three broad perspectives of NOS scale: the selection of the study groups, the comparability of the groups, and the ascertainment of the outcome of interest. A study can receive a maximum of nine stars; the studies with eight to nine, six to seven, and ≤6 stars represent the high, medium, and low quality of the study, respectively …”

“…A study can receive a maximum of nine stars; the studies with eight to nine, six to seven, and ≤6 stars represent the high, medium, and low quality of the study, respectively. [20][21][22] Data extraction. A pre-designed data extraction template was used to abstract the following information: study author, publication year, study design, study period, data source, follow-up period, mean age of the patients, size of the cohort, number of warfarin user and non-user (patients using any drug other than warfarin), ascertainment of outcome (bleeding), and HR or RR after adjustment for the confounding factors.…”

Peptic ulcer disease

“…Approximately half of older patients in primary care using NSAIDs were prescribed higher than therapeutic doses or double dose regimens of PPIs in a national audit in Bahrain 55. This overuse results in unnecessary healthcare costs and an increased risk of adverse effects, such as hip fracture,56 cardiovascular events,57 Clostridium difficile infection, pneumonia, dementia,58 and gastric cancer in long term users 5960. The evidence regarding these side effects is largely derived from observational studies, with a risk of confounding,61 but the potential harms need to be considered in the scenario of overuse and long term use.…”

A population-based study of prescribing trends in a potentially vulnerable paediatric population from 1999 to 2012

“…Though the use of PPIs is generally well tolerated in the short term, their use is also associated with clostridium difficile infections and community‐acquired pneumonia in paediatric populations. In adult populations, fracture risk is known to be increased after prolonged PPI therapy . There has been limited research into the long‐term effects of these agents in paediatric populations and with the increased use of these agents shown in our study, and internationally, it is important that research be focused in this area.…”