Proton-pump inhibitors and risk of fractures: an update meta-analysis
- PMID: 26462494
- DOI: 10.1007/s00198-015-3365-x
Proton-pump inhibitors and risk of fractures: an update meta-analysis
Abstract
To identify the relationship between proton-pump inhibitors (PPIs) and the risk of fracture, we conducted an update meta-analysis of observational studies. Results showed that PPI use was associated with a modestly increased risk of hip, spine, and any-site fracture.
Introduction: Many studies have investigated the association of proton-pump inhibitors (PPIs) with fracture risk, but the results have been inconsistent. To evaluate this question, we performed a meta-analysis of relevant observational studies.
Methods: A systematic literature search up to February 2015 was performed in PubMed. We combined relative risks (RRs) for fractures using random-effects models and conducted subgroup and stratified analyses.
Results: Eighteen studies involving a total of 244,109 fracture cases were included in this meta-analysis. Pooled analysis showed that PPI use could moderately increase the risk of hip fracture [RR = 1.26, 95 % confidence intervals (CIs) 1.16–1.36]. There was statistically significant heterogeneity among studies (p < 0.001; I 2 = 71.9 %). After limiting to cohort studies, there was also a moderate increase in hip fracture risk without evidence of study heterogeneity. Pooling revealed that short-term use (<1 year) and longer use (>1 year) were similarly associated with increased risk of hip fracture. Furthermore, a moderately increased risk of spine (RR = 1.58, 95 % CI 1.38–1.82) and any-site fracture (RR = 1.33, 95 % CI 1.15–1.54) was also found among PPI users.
Conclusion: In this update meta-analysis of observational studies, PPI use modestly increased the risk of hip, spine, and any-site fracture, but no evidence of duration effect in subgroup analysis.
Comment in
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Calcium, proton pump inhibitors, and fracture risk.Osteoporos Int. 2016 Jan;27(1):349-50. doi: 10.1007/s00198-015-3403-8. Epub 2015 Nov 10. Osteoporos Int. 2016. PMID: 26556735 No abstract available.
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Proton pump inhibitors and fracture risk: response to comments.Osteoporos Int. 2016 Apr;27(4):1673-1674. doi: 10.1007/s00198-015-3434-1. Epub 2015 Nov 24. Osteoporos Int. 2016. PMID: 26602916 No abstract available.
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Proton pump inhibitors and fracture: do they do what it says on the tin?Osteoporos Int. 2016 Apr;27(4):1671-1672. doi: 10.1007/s00198-016-3497-7. Epub 2016 Feb 4. Osteoporos Int. 2016. PMID: 26846774 No abstract available.
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