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Proton pump inhibitors may increase fracture risk in older women
Older women who use proton pump inhibitors to reduce stomach acid may increase their risk for fracture, according to research in Bone.
In a prospective cohort study examining the dose and type of proton pump inhibitors (PPIs) and their possible associations with bone health in older Australian women, researchers found that PPI use — particularly rabeprazole and esomeprazole — was linked to an increased use of subsequent osteoporosis medication and hospitalization for fracture in older women.
“The current results support the hypothesis that PPI use negatively affects bone health,” the researchers wrote. “These findings foreshadow the need for a more cautious approach than the current widespread prescribing of PPIs.”
Mari ë lle M.C. van der Hoorn, of the University of Queensland School of Public Health in Brisbane, Australia, and colleagues analyzed survey data from 4,432 women born between 1921 and 1926 who participated in the Australian Longitudinal Study on Women’s Health. Researchers analyzed medication use (prescriptions for PPIs and osteoporosis medications) and fracture rates by electronic hospital records and Pharmaceutical Benefits Scheme data linked to survey participants. Linked hospital data were available for 62% of the cohort. Researchers used competing risk regression models, taking into account competing risks and analyzing PPI use as a time-dependent covariate.
Within the cohort, 2,328 women were prescribed PPI therapy during 6.6 years of follow-up. Researchers found that 36% of PPI users were subsequently prescribed osteoporosis medication vs. 26% of those who did not use PPI therapy. Women prescribed PPI therapy had an increased risk for future osteoporosis medication use, with an adjusted subhazard ratio (SHR) of 1.28 (95% CI, 1.13-1.44) and an SHR rate of 1.29 (95% CI, 1.08-1.55) for fracture.
After analyzing PPIs by type, researchers found an increased risk for osteoporosis medication use for women prescribed rabeprazole (SHR = 1.51; 95% CI, 1.08-2.1) and esomeprazole (SHR = 1.48; 95% CI, 1.17-1.88), the most commonly prescribed PPI (22.9%). Researchers also found an increased fracture risk for women prescribed rabeprazole (SHR = 2.06; 95% CI, 1.37-3.1). There was some evidence for a dose-response association, according to researchers. – by Regina Schaffer
Disclosure: The researchers report no relevant financial disclosures.