Do PPIs increase the risk of fractures in postmenopausal women?

January 01, 0001

Do PPIs increase the risk of fractures in postmenopausal women?

Proton pump inhibitor (PPI) medications have been inconsistently shown to be associated with osteoporotic fractures. These US authors examined the association of PPI use with bone outcomes using data from the Women’s Health Initiative (WHI) observational study and clinical trials. This was a prospective cohort analysis including 161,806 postmenopausal women 50 to 79 years old, without history of hip fracture. Mean follow-up was 7.8 years. Analyses were conducted for 130,487 women with complete information. Medication information was taken directly from drug containers during in- person interviews at baseline and year 3.

They found: "During 1,005,126 person-years of follow-up, 1500 hip fractures, 4881 forearm or wrist fractures, 2315 clinical spine fractures, and 21,247 total fractures occurred. The multivariate-adjusted hazard ratios for current PPI use were 1.00 for hip fracture, 1.47 (significant) for clinical spine fracture, 1.26 (significant) for forearm or wrist fracture, and 1.25 (significant) for total fractures. The BMD measurements did not vary between PPI users and nonusers at baseline. Use of PPIs was associated with only a marginal effect on 3-year BMD change at the hip (P = .05) but not at other sites."

The authors concluded: "Use of PPIs was not associated with hip fractures but was modestly associated with clinical spine, forearm or wrist, and total fractures."

The answer appears to be that the use of PPIs in postmenopausal increases the risk of fracture a little bit.

For the full abstract, click here.

Arch Intern Med 170(9):765-771, 10 May 2010
© 2010 to the American Medical Association
Proton Pump Inhibitor Use, Hip Fracture, and Change in Bone Mineral Density in Postmenopausal Women-Results From the Women's Health Initiative. Shelly L. Gray, Andrea Z. LaCroix, Joseph Larson, et al.

Category: M. Musculoskeletal. Keywords: proton pump inhibitors, PPIs, postmenopausal women, fractures, bone mineral density, prospective cohort study, journal watch.
Synopsis edited by Dr Linda French, Toledo, Ohio. Posted on Global Family Doctor 1 June 2010

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.