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Proton Pump Inhibitors and Fracture Risk

True Effect or Residual Confounding?

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Abstract

Fracture is a major contributor to human morbidity and mortality, especially in the elderly. It has been discussed in the literature that conditions associated with decreased stomach acidity may lead to a decrease in intestinal calcium absorption and, consequently, to an increased fracture risk. In recent years, several observational studies reported a slightly increased fracture risk in association with the use of proton pump inhibitors (PPIs) and/or histamine H2 receptor antagonists. It was the objective of this review to critically assess the available evidence linking PPI use to an increased fracture risk. A MEDLINE and EMBASE search from 1960 to June 2010 was performed to identify the relevant articles using predefined search terms. Because (i) there is no proven mechanism, (ii) the reported magnitude of the risk elevation associated with the use of PPIs was only weak, and (iii) the likelihood of residual confounding despite adjustment for known co-morbidities and drug use cannot be ruled out, we conclude that the currently available literature does not support the notion that the use of PPIs is causally related to a materially increased fracture risk in humans.

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Authors and Affiliations

  1. Division of Clinical Pharmacology and Toxicology, University Hospital Basel, Basel, Switzerland

    Michael Bodmer

  2. Rocky Mountain Poison and Drug Center, Denver, Colorado, USA

    Michael Bodmer

  3. Division of Endocrinology, Diabetes and Clinical Nutrition, University Hospital Basel, Basel, Switzerland

    Christian Meier & Marius E. Kraenzlin

  4. Basel Pharmacoepidemiology Unit, Division of Clinical Pharmacy and Epidemiology, Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland

    Christoph R. Meier

  5. Hospital Pharmacy, University Hospital Basel, Basel, Switzerland

    Christoph R. Meier

  6. Boston Collaborative Drug Surveillance Program (BCDSP), Boston University Medical Center, Lexington, Massachusetts, USA

    Christoph R. Meier

Authors
  1. Michael Bodmer
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  2. Christian Meier
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  3. Marius E. Kraenzlin
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  4. Christoph R. Meier
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Correspondence to Christian Meier.

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Bodmer, M., Meier, C., Kraenzlin, M.E. et al. Proton Pump Inhibitors and Fracture Risk. Drug-Safety 33, 843–852 (2010). https://doi.org/10.2165/11536780-000000000-00000

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  • DOI: https://doi.org/10.2165/11536780-000000000-00000

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