RT Journal Article
SR Electronic
T1 Use of Acid-Suppressive Drugs and Risk of Fracture: A Meta-analysis of Observational Studies
JF The Annals of Family Medicine
JO Ann Fam Med
FD American Academy of Family Physicians
SP 257
OP 267
DO 10.1370/afm.1243
VO 9
IS 3
A1 Eom, Chun-Sick
A1 Park, Sang Min
A1 Myung, Seung-Kwon
A1 Yun, Jae Moon
A1 Ahn, Jeong-Soo
YR 2011
UL http://www.annfammed.org/content/9/3/257.abstract
AB 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.