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Senior Citizen Health & Medicine
Acid Suppression Medication Linked With Increased
Risk of Hip Fracture
Association with hip
fractures increased with both dosage and duration of PPI
December 26, 2006 - 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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