| (PHILADELPHIA) – Use of proton
pump inhibitor (PPI) drugs for the treatment of acid-related diseases
such as gastroesophageal
reflux disease (GERD) is associated with a greater risk of hip
fracture, according to a study in the December 27 issue of the Journal
of the American Medical Association.
Potent acid suppressive medications such as PPIs have revolutionized the management
of acid-related diseases. According to the article, millions of
individuals have been using these medications on a continuous or
long-term basis. Some research has shown that PPI therapy may decrease
insoluble calcium absorption or bone density in certain patients.
These factors could increase the risk for hip fracture, which has
a death rate during the first year after the fracture of 20 percent.
Among those who survive this period, one in five require nursing
home care and often an emergency department visit, hospitalization,
surgery, and rehabilitation, with huge health care costs.
Yang, MD, MSCE, of the University
of Pennsylvania School of Medicine’s Division
of Gastroenterology, conducted a study to determine what effects
PPI therapy has on bone metabolism and hip fracture risk in a large
group representative of the general population. The researchers
analyzed data from the General
Practice Research Database (1987-2003), which contains information
on patients in the United Kingdom. The study group consisted of
users of PPI therapy and nonusers of acid suppression drugs who
were older than 50 years of age.
There were 13,556 hip fracture cases and 135,386 controls. The
researchers found that more than one year of PPI therapy was associated
with a 44 percent increased risk of hip fracture. The risk was 2.6
times higher among long-term users of high-dose PPI therapy. The
strength of the association with hip fractures increased with both
the dosage and the duration of PPI therapy.
According to the authors, “… we observed that PPI therapy
is associated with a significantly increased risk of hip fractures,
with the highest risk seen among those receiving high-dose PPI therapy.
Osteoporotic fractures are common among the elderly population,
and they entail considerable morbidity and mortality. On the other
hand, PPI therapy is widespread and may have an exaggerated effect
among those at risk for osteoporosis.
Thus, further studies are urgently needed to confirm our findings
and clarify the underlying mechanism.
“At this point, physicians should be aware of this potential
association when considering PPI therapy and should use the lowest
effective dose for patients with appropriate indications. For elderly
patients who require long-term and particularly high-dose PPI therapy,
it may be prudent to reemphasize increased calcium intake, preferably
from a dairy source, and co-ingestion of a meal when taking insoluble
calcium supplements,” the authors write.
PENN Medicine is a $2.9 billion enterprise
dedicated to the related missions of medical education, biomedical
research, and high-quality patient care. PENN Medicine consists
of the University of Pennsylvania School of Medicine (founded in
1765 as the nation's first medical school) and the University of
Pennsylvania Health System.
Penn's School of Medicine is ranked #2 in the nation for receipt
of NIH research funds; and ranked #3 in the nation in U.S. News
& World Report's most recent ranking of top research-oriented
medical schools. Supporting 1,400 fulltime faculty and 700 students,
the School of Medicine is recognized worldwide for its superior
education and training of the next generation of physician-scientists
and leaders of academic medicine.
The University of Pennsylvania Health System includes three hospitals,
all of which have received numerous national patient-care honors [Hospital
of the University of Pennsylvania; Pennsylvania Hospital, the nation's
first hospital; and Penn Presbyterian Medical Center]; a faculty practice
plan; a primary-care provider network; two multispecialty satellite
facilities; and home care and hospice.