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

Abstract Purpose Previous studies have reported inconsistent findings regarding the association between the use of acid-suppressive drugs such as proton pump inhibitors (PPIs) and histamine 2 receptor antagonists (H2 RAs) and fracture risk. We investigated this association using meta-analysis. Metho...

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Bibliographic Details
Published in:Annals of family medicine 2011-05, Vol.9 (3), p.257-267
Main Authors: Eom, Chun-Sick, MD, MPH, Park, Sang Min, MD, MPH, PhD, Myung, Seung-Kwon, MD, MS, Yun, Jae Moon, MD, Ahn, Jeong-Soo, MD, MS
Format: Article
Language:English
Subjects:
Anti-Ulcer Agents - adverse effects
Cimetidine - adverse effects
Confidence Intervals
Fractures, Bone - chemically induced
Fractures, Bone - epidemiology
Fractures, Bone - etiology
Gastric Acid - secretion
Gastroesophageal Reflux - drug therapy
Histamine H2 Antagonists - adverse effects
Histamine H2 Antagonists - therapeutic use
Humans
Internal Medicine
Odds Ratio
Proton Pump Inhibitors - adverse effects
Proton Pump Inhibitors - therapeutic use
Risk Assessment - methods
Risk Factors
Systematic Reviews
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Summary:Abstract Purpose Previous studies have reported inconsistent findings regarding the association between the use of acid-suppressive drugs such as proton pump inhibitors (PPIs) and histamine 2 receptor antagonists (H2 RAs) and fracture risk. We investigated this association using meta-analysis. Methods We 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 final analyses. The pooled odds ratio (OR) for fracture was 1.29 (95% confidence interval [CI], 1.18–1.41) with use of PPIs and 1.10 (95% CI, 0.99–1.23) with use of H2 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 H2 RA use was not significantly associated with fracture risk. Conclusions We found possible evidence linking PPI use to an increased risk of fracture, but no association between H2 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.
ISSN:1544-1709
1544-1717
DOI:10.1370/afm.1243