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Research ArticleSystematic Reviews

Use of Acid-Suppressive Drugs and Risk of Fracture: A Meta-analysis of Observational Studies

Chun-Sick Eom, Sang Min Park, Seung-Kwon Myung, Jae Moon Yun and Jeong-Soo Ahn
The Annals of Family Medicine May 2011, 9 (3) 257-267; DOI: https://doi.org/10.1370/afm.1243
Chun-Sick Eom
MD, MPH
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Sang Min Park
MD, MPH, PhD
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Seung-Kwon Myung
MD, MS
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Jae Moon Yun
MD
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Jeong-Soo Ahn
MD, MS
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Abstract

PURPOSE Previous studies have reported inconsistent findings regarding the association between the use of acid-suppressive drugs such as proton pump inhibitors (PPIs) and histamine 2 receptor antagonists (H2RAs) and fracture risk. We investigated this association using meta-analysis.

METHODS We searched MEDLINE (PubMed), EMBASE, and the Cochrane Library from inception through December 2010 using common key words. We included case-control, nested case-control, and cohort studies. Two evaluators independently reviewed and selected articles. We determined pooled effect estimates by using random-effects meta-analysis, because of heterogeneity.

RESULTS Of 1,809 articles meeting our initial inclusion criteria, 5 case-control studies, 3 nested case-control studies, and 3 cohort studies were included in the final analyses. The pooled odds ratio (OR) for fracture was 1.29 (95% confidence interval [CI], 1.18–1.41) with use of PPIs and 1.10 (95% CI, 0.99–1.23) with use of H2RAs when compared with nonuse of the respective medications. Long-term use of PPIs increased the risk of any fracture (adjusted OR = 1.30; 95% CI, 1.15–1.48) and hip fracture risk (adjusted OR = 1.34; 95% CI, 1.09–1.66), whereas long-term H2RA use was not significantly associated with fracture risk.

CONCLUSIONS We found possible evidence linking PPI use to an increased risk of fracture, but no association between H2RA use and fracture risk. Widespread use of PPIs with the potential risk of fracture is of great importance to public health. Clinicians should carefully consider their decision to prescribe PPIs for patients already having an elevated risk of fracture because of age or other factors.

  • Proton pump inhibitors
  • H2-receptor antagonists
  • fracture risk
  • meta-analysis
  • Received for publication October 11, 2010.
  • Revision received December 16, 2010.
  • Accepted for publication January 6, 2011.
  • © 2011 Annals of Family Medicine, Inc.
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The Annals of Family Medicine: 9 (3)
The Annals of Family Medicine: 9 (3)
Vol. 9, Issue 3
1 May 2011
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Use of Acid-Suppressive Drugs and Risk of Fracture: A Meta-analysis of Observational Studies
Chun-Sick Eom, Sang Min Park, Seung-Kwon Myung, Jae Moon Yun, Jeong-Soo Ahn
The Annals of Family Medicine May 2011, 9 (3) 257-267; DOI: 10.1370/afm.1243

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Use of Acid-Suppressive Drugs and Risk of Fracture: A Meta-analysis of Observational Studies
Chun-Sick Eom, Sang Min Park, Seung-Kwon Myung, Jae Moon Yun, Jeong-Soo Ahn
The Annals of Family Medicine May 2011, 9 (3) 257-267; DOI: 10.1370/afm.1243
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