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Continued use of proton pump inhibitors increases risk of bone fractures

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Patients who use proton pump inhibitors for 7 or more years to treat reflux, peptic ulcers and other conditions are at greater risk of osteoporosis-related fractures, according to an observational study of more than 15,000 patients with such fractures, published in the Aug. 12 issue of the Canadian Medical Association Journal.

Researchers from the University of Manitoba in Winnipeg said in their abstract that use of proton pump inhibitors – a class of drugs commonly prescribed to control and prevent symptoms and complications of peptic ulcer disease and GERD (reflux) – has increased in recent years, and use is often of indefinite duration.

Unfortunately, "These factors may promote the long-term use of proton pump inhibitors, leaving patients at increased risk of osteoporosis-related fractures," co-author Laura E. Targownik, MD, MSHS, said in a press release.

The investigators compared 15,792 patients aged 50 years and older who had hip, spinal, or wrist fractures to a control group of 47,289 patients who were matched by age, sex and comorbidities but had no history of hip, spinal or wrist fractures.

They said there was an increased risk of hip fracture after 5 years of continuous exposure to the proton pump inhibitors and an increased risk of any fracture after 7 years of continuous exposure. Short-term exposure did not appear to increase their risk of fractures, according to the press release.

In a related commentary, J. Brent Richards, MD, and David Goltzman, MD, said researchers involved with three large administrative database studies also found that proton pump inhibitors increase fracture risk.

They said the association between the use of proton pump inhibitors and osteoporotic fractures may involve calcium malabsorption due to induced hypochlorhydria, but this remains unproven. They added that the findings of the retrospective administrative database studies should be confirmed by randomized controlled trials or prospective cohort studies.

In the press release, Richards and Goltzman cautioned that physicians and patients should work together to weigh the risks and benefits of using these drugs on a long-term basis.

For more information:

• Richards JB, Goltzman D. Proton pump inhibitors: balancing the benefits and potential fracture risks. Can Med Assoc J. 2008:179(4):306-7.
• Targownik LE, Lix LM, Metge CJ, et al. Use of proton pump inhibitors and risk of osteoporosis-related fractures. Can Med Assoc J. 2008;179(4):319-26.