JAMA: Acid suppression medication linked with increased risk of hip fracture

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Public release date: 26-Dec-2006

http://www.eurekalert.org/pub_releases/2006-12/jaaj-asm122106.php

Contact: Olivia Fermano

JAMA and Archives Journals

Acid suppression medication linked with increased risk of hip fracture

Use of the drugs proton pump inhibitors (PPIs) for the treatment of

acid-related diseases such as gastro esophageal reflux disease (GERD) is

associated with a greater risk of hip fracture, according to a study in

the December 27 issue of JAMA.

Potent acid suppressive medications such as PPIs have revolutionized the

management of acid-related diseases. Millions of individuals have been

using these medications on a continuous or long-term basis, according to

background information in the article. Some research has shown that PPI

therapy may decrease insoluble calcium absorption or bone density in

certain patients. These factors could increase the risk for hip

fracture, which has a death rate during the first year after the

fracture of 20 percent. Among those who survive this period, 1 in 5

require nursing home care and often an emergency department visit,

hospitalization, surgery, and rehabilitation, with huge health care costs.

Yu-Xiao Yang, M.D., M.S.C.E., of the University of Pennsylvania School

of Medicine, Philadelphia, conducted a study to determine what effects

PPI therapy has on bone metabolism and hip fracture risk in a large

group representative of the general population. The researchers analyzed

data from the General Practice Research Database (1987-2003), which

contains information on patients in the United Kingdom. The study group

consisted of users of PPI therapy and nonusers of acid suppression drugs

who were older than 50 years.

There were 13,556 hip fracture cases and 135,386 controls. The

researchers found that more than 1 year of PPI therapy was associated

with a 44 percent increased risk of hip fracture. The risk was 2.6 times

higher among long-term users of high-dose PPI therapy. The strength of

the association with hip fractures increased with both the dosage and

the duration of PPI therapy.

" In summary, we observed that PPI therapy is associated with a

significantly increased risk of hip fractures, with the highest risk

seen among those receiving high-dose PPI therapy. Osteoporotic fractures

are common among the elderly population, and they entail considerable

morbidity and mortality. On the other hand, PPI therapy is widespread

and may have an exaggerated effect among those at risk for osteoporosis.

Thus, further studies are urgently needed to confirm our findings and

clarify the underlying mechanism.

" At this point, physicians should be aware of this potential association

when considering PPI therapy and should use the lowest effective dose

for patients with appropriate indications. For elderly patients who

require long-term and particularly high-dose PPI therapy, it may be

prudent to reemphasize increased calcium intake, preferably from a dairy

source, and co-ingestion of a meal when taking insoluble calcium

supplements, " the authors write.

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(JAMA. 2006;296:2947-2953. Available pre-embargo to the media at

www.jamamedia.org)

Editor's Note: Please see the article for additional information,

including other authors, author contributions and affiliations,

financial disclosures, funding and support, etc.

For More Information: Contact the JAMA/Archives Media Relations

Department at 312-464-JAMA or email: mediarelations@....

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