Proton pump inhibitors in long-term use: recent epidemiological evidence of increased risk of fracture

Observational studies on a risk of fracture associated with PPIs suggest there may be a modest increase in the risk of hip, wrist, or spine fracture, especially if PPIs are used in high doses and over long durations (>1 year). The increased risk was observed mainly in elderly patients, and it is possible that other risk factors contribute to the increase in risk.

Two meta-analysesEom CS, et al. Ann Fam Med 2011; 9: 257–67 Kwok CS, et al. Bone 2011; 48: 768–76of published pharmacoepidemiology studies suggest the risk of fracture is increased by 10–40% above baseline. The primary studies in these analyses have varied in the extent to which they have adjusted for other potential risk factors for fracture, and use of calcium or vitamin D.

Patients at risk of osteoporosis should be treated according to current clinical guidelines to ensure they have an adequate intake of vitamin D and calcium.

PPIs obtained over the counter

The observed increase in risk of fracture has been associated with prolonged use of PPIs (>1 year). PPIs obtained without prescription over-the-counter should not be used for more than 4 weeks without consulting a doctor. If no symptom relief is obtained within 2 weeks of continuous treatment, the patient should consult a doctor. Provided that PPIs obtained over the counter are taken short-term and according to the recommended posology, their use is not expected to significantly increase the risk of fracture.
 

Further information

BNF section 1.3.5 Proton pump inhibitors 

Article citation: Drug Safety Update April 2012, vol 5 issue 9: A2.