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Infant antacid use linked to increased fracture risk in childhood

Infants prescribed antacid medications, such as histamine H2-receptor antagonists and proton pump inhibitors, to manage gastroesophageal reflux exhibited increased risks for bone fractures later in childhood, according to research presented at the 2017 Pediatric Academic Societies Meeting.

“With many antacids easily available over the counter for adults, these medications may seem benign,” U.S. Airforce Capt. Laura Malchodi, MD, a pediatrics resident at Walter Reed National Military Medical Center, said in a press release. “However, our study adds to a growing body of evidence suggesting antacid medications are not safe for children, especially very young children.”

Laura Malchodi

To assess the effects of antacid use in children aged up to 6 months, especially the use of histamine H2-receptor antagonists (H2RAs) and proton pump inhibitors (PPIs), researchers conducted a retrospective cohort study of healthy children (n = 874,447) who were born between 2001 and 2013 within the Military Healthcare System. Information concerning prescriptions within the first 6 months of life was obtained through outpatient pharmacy data, and fractures acquired after 6 months were identified through the ICD-9.

Malchodi and colleagues excluded children from the study if they had diagnosed osteogenesis imperfecta, pathologic fractures, child maltreatment or an NICU stay of 1 week or longer.

The researchers noted that H2RAs were prescribed to 7.7% of children in the cohort (at a median of 3.0 months), whereas PPIs were prescribed to 0.8% of children (3.5 months), with both antacids prescribed to 1.2% of infants (2.9 months).

According to study results, children who were prescribed PPIs exhibited a 22% increased risk of fracture, whereas children who were administered both PPIs and H2RAs exhibited a 31% increased risk of fracture. Although using only H2RAs had no correlation with increased risk of fracture, an increased time of use was related to a higher chance of fracture.

Additionally, Malchodi and colleagues observed that the number of bone fractures increased with the number of days children took these medications; the younger an infant began using antacid medications, the greater the fracture risk, with infants aged less than 6 months experiencing the most significant risk of fracture.

The researchers also found that children who were born with a low birth weight were at less risk of fracture, and preterm infants had no correlation with fracture hazard.

Malchodi suggests that antacids “should only be prescribed to treat confirmed serious cases of more severe symptomatic gastroesophageal reflux disease and for the shortest length of time needed.” — by Katherine Bortz.

Reference:

Malchodi L, et al. “Early Antacid Exposure Increases Fracture Risk in Young Children” Presented at: The Pediatric Academic Societies Meeting; May 6-9, 2017; San Francisco, CA.