As per a meta-analysis of observational studies reported
online Dec. 12, 2018 in the journal Osteoporosis International, proton pump
inhibitors (PPIs) are significantly associated with an increased risk of hip
fracture. This effect is not seen with histamine 2 receptor antagonists
(H2RAs).
The meta-analysis included 24 observational studies with
2,103,800 participants. Of these, 319,568 were hip fracture patients. Analysis
showed that patients on PPIs had a greater risk of hip fracture than those who
were not on PPI (risk ratio 1.20; p < 0.0001).
The risk increased with the dose of PPIs. The observed
risk was high for both low and medium doses of PPIs and it was even greater for
patients taking high dose PPIs; low dose RR 1.17 (p = 0.002); medium dose RR
1.28 (p <0.0001) and higher dose RR 1.30 (p <0.0001).
But no association was found between the use of H2RAs and
increased risk of hip fracture.
The study recommends cautious prescription of PPIs,
especially long-term and higher dose PPIs, in patients who are at high risk of
hip fracture. The authors further say that “patients should be concerned about
the inappropriate use of PPIs; if necessary, then, they should continue to
receive it with a clear indication”.
Dr KK Aggarwal
Padma Shri Awardee
President Elect Confederation of Medical
Associations in Asia and Oceania
(CMAAO)
Group Editor-in-Chief IJCP Publications
President Heart Care Foundation of India
Past National President IMA
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