Use of proton pump inhibitors and risk of osteoporosis-related fractures

The use of proton pump inhibitors has been associated with an increased risk of hip fracture. The authors of a recent study [1] sought to further explore the relation between duration of exposure to proton pump inhibitors and osteoporosis-related fractures. They used administrative claims data to identify patients with a fracture of the hip, vertebra, or wrist between April 1996 and March 2004. Cases were each matched with 3 controls based on age, sex, and comorbidities. They calculated adjusted odds ratios (OR) for the risk of hip fracture and all osteoporosis-related fractures for durations of proton pump inhibitor exposure ranging from 1 or more years to more than 7 years.

The authors matched 15 792 cases of osteoporosis-related fractures with 47 289 controls. They did not detect a significant association between the overall risk of an osteoporotic fracture and the use of proton pump inhibitors for durations of 6 years or less. However, exposure of 7 or more years was associated with increased risk of an osteoporosis-related fracture (adjusted OR 1.92, P = 0.011). They also found an increased risk of hip fracture after 5 or more years of exposure (adjusted OR 1.62, P = 0.04), with even higher risk after 7 or more years exposure (adjusted OR 4.55, P = 0.002).

Use of proton pump inhibitors for 7 or more years is associated with a significantly increased risk of an osteoporosis-related fracture. There is an increased risk of hip fracture after 5 or more years exposure. Further study is required to determine the clinical importance of this finding and to determine the value of osteoprotective medications for patients associated with long-term use of proton pump inhibitors.

1. Laura E. Targownik LE et al. CMAJ. 2008;179:319-326.