Proton Pump Inhibitors May Increase Fracture Risk in Postmenopausal Women
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In a prospective analysis of data from the Women’s Health Initiative, postmenopausal women who used proton pump inhibitors (PPIs) were found to have a modestly increased risk of clinical spine fractures, forearm or wrist fractures, and total fractures. PPI use was not associated with hip fractures.
The analysis encompassed data from 161,806 women 50 to 79 years of age and reflected more than 1 million person-years of follow-up. A total of 3,396 women (2.1%) were using a PPI (omeprazole or lansoprazole) at baseline. Of those women, 392 (11.5%) had used a PPI for more than 3 years, 1,520 (44.8%) had used a PPI for 1 to 3 years, and 1,484 (43.7%) had used a PPI for less than 1 year.
During follow-up, the women in the study cohort experienced 1,500 hip fractures; 4,881 forearm or wrist fractures; 2,315 clinical spine fractures; and 21,247 total fractures. The multivariate-adjusted hazard ratios for current PPI use were 1.00 (95% CI, 0.71–1.40) for hip fracture, 1.47 (95% CI, 1.18–1.82) for clinical spine fracture, 1.26 (95% CI, 1.05–1.51) for forearm or wrist fracture, and 1.25 (95% CI, 1.15–1.36) for total fractures.
The authors recommended that clinicians periodically reevaluate the need for long-term PPI therapy. When long-term therapy is required in older adults, the focus should be on using the lowest effective PPI dose, ensuring adequate dietary calcium intake, and adding calcium supplements when necessary.
Arch Intern Med. 2010;170(9):765-71.