Seven years’ proton pump inhibitor use linked to increased osteoporotic fracture risk

Use of proton pump inhibitors (e.g. Losec, Protium, Pariet etc) for seven years or more is associated with increased risk of osteoporosis-related fractures, and risk increases with duration of exposure, a new study indicates (Canadian Medical Association Journal 2008;179:319). Data from the study also suggest that short-term use does not increase fracture risk.

Using data from a Canadian administrative claims database, researchers matched 15,792 patients aged 50 years or older with osteoporosis-related fractures of the hip, vertebra or wrist with 47,289 controls. They found that the risk of any osteoporotic fracture was increased after at least seven years of continuous exposure to proton pump inhibitors. The risk of hip fracture was increased after five or more years of continuous exposure, with even higher risk after seven years or more.

A related commentary points out that a previous study showed an increased risk of hip fracture after only one year of treatment. It is possible that this discrepancy is a matter of statistical power but it is suggested that the issue has considerable clinical significance and needs to be resolved.

The study concludes “The fact that three large, well-designed studies consistently report an association between the use of proton pump inhibitors and fractures and that this association appears to be both dose- and duration-dependent is certainly a strong basis for encouraging further investigation.”