PPI use associated with diminished antifracture efficacy of alendronate

January 01, 0001

PPI use associated with diminished antifracture efficacy of alendronate

Biologically, PPIs could affect the absorption of calcium, vitamin B12, and bisphosphonates and could affect the osteoclast proton pump, thus interacting with bisphosphonate antifracture efficacy. Moreover, PPIs themselves have been linked to osteoporotic fractures. These Danish authors conducted a population-based, national register-based, open cohort study of 38,088 new alendronate sodium users with a mean duration of follow-up of 3.5 years. They related risk of hip fracture to recent pharmacy records of refill of prescriptions for alendronate.

The authors concluded: "Concurrent PPI use was associated with a dose-dependent loss of protection against hip fracture with alendronate in elderly patients. This is an observational study, so a formal proof of causality cannot be made, but the dose-response relationship and the lack of impact of prior PPI use provides reasonable grounds for discouraging the use of PPIs to control upper gastrointestinal tract complaints in patients treated with oral bisphosphonates."

The body of evidence to discourage long-term PPI use in the elderly is growing.


For the full abstract, click here.

Arch Intern Med 171(11):998-1004, 13 June 2011 © 2011 to the American Medical Association
Proton Pump Inhibitor Use and the Antifracture Efficacy of Alendronate. Bo Abrahamsen, Pia Eiken, Richard Eastell. Correspondence to Dr. Abrahamsen: [email protected]

Category: D. Digestive, M. Musculoskeletal. Keywords: proton pump inhibitor, PPI, alendronate, hip fracture, cohort study, journal watch.
Synopsis edited by Dr Linda French, Toledo, Ohio. Posted on Global Family Doctor 28 June 2011

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

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