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Meta-Analysis
. 2011 May-Jun;9(3):257-67.
doi: 10.1370/afm.1243.

Use of acid-suppressive drugs and risk of fracture: a meta-analysis of observational studies

Chun-Sick Eom  1 , Sang Min Park, Seung-Kwon Myung, Jae Moon Yun, Jeong-Soo Ahn
Affiliations
Meta-Analysis

Use of acid-suppressive drugs and risk of fracture: a meta-analysis of observational studies

Chun-Sick Eom et al. Ann Fam Med. 2011 May-Jun.

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 (H(2)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 H(2)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 H(2)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 H(2)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.

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Figures

Figure 1.
Figure 1.
Study flow diagram.
Figure 2.
Figure 2.
PPIs or H2 RAs use and the combined risk of any fracture in a random-effects model meta-analysis of case-controls studies and cohort studies. CI=confidence interval; H2RA = histamine 2 receptor antagonist; OR = odds ratio; PPI = proton pump inhibitor; RR = relative risk.
Figure 2.
Figure 2.
PPIs or H2 RAs use and the combined risk of any fracture in a random-effects model meta-analysis of case-controls studies and cohort studies. CI=confidence interval; H2RA = histamine 2 receptor antagonist; OR = odds ratio; PPI = proton pump inhibitor; RR = relative risk.
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References

    1. CAG Clinical Affairs Committee. Community-acquired pneumonia and acid-suppressive drugs: position statement. Can J Gastroenterol. 2006;20(2):119–121, 123–125. - PMC - PubMed
    1. Eastell R, Lambert H. Strategies for skeletal health in the elderly. Proc Nutr Soc. 2002;61(2):173–180. - PubMed
    1. Seeman E, Bianchi G, Adami S, Kanis J, Khosla S, Orwoll E. Osteoporosis in men—consensus is premature. Calcif Tissue Int. 2004; 75(2):120–122. - PubMed
    1. Roughead EE, Ramsay EN, Pratt NL, Ryan P, Gilbert AL. Proton-pump inhibitors and the risk of antibiotic use and hospitalisation for pneumonia. Med J Aust. 2009;190(3):114–116. - PubMed
    1. Jacobson BC, Ferris TG, Shea TL, Mahlis EM, Lee TH, Wang TC. Who is using chronic acid suppression therapy and why? Am J Gas-troenterol. 2003;98(1):51–58. - PubMed

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