What is it about?

We performed a meta-analysis of relevant studies to quantify the magnitude of the association between proton pump inhibitors (PPIs) and risk of hip fracture. Patients with PPIs had a greater risk of hip fracture than those without PPI therapy (RR 1.20, 95% CI 1.14–1.28, p < 0.0001). These results could be taken into consideration with caution, and patients should also be concerned about the inappropriate use of PPIs.

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Why is it important?

Proton pump inhibitors (PPIs) are generally considered as first-line medicine with great safety profile, commonly prescribed for gastroesophageal reflux disease (GERD) and peptic ulcer disease. However, several epidemiological studies documented that long-term use of PPIs may be associated with an increased risk of hip fracture. Our results suggest that PPI use is significantly associated with an increased risk of hip fracture development, which is not observed in H2RA exposure. Physicians should, therefore, exercise caution when considering a long-term PPI treatment to their patients who already have an elevated risk of hip fracture.


Our current meta-analysis provides an evidence for the significant association between PPI use and hip fracture risk. Indeed, patients who used PPIs for more than 3 years had a 24% increased risk of hip fracture compared with non-users. We also observed that short-term (< 1 year) and intermediate (1–2 years) users had a higher risk of hip fracture. To evaluate the potential dose-response relationship, we stratified PPI use into three categories and observed a statistically significant trend between the dose and the risk of hip fracture. The risk appeared to be even greater in patients with the higher dose. In contrary, no association was observed between H2RA use and hip fracture among studies examining participants taking H2RA therapy alone.

Md.Mohaimenul Islam
Taipei Medical University

Read the Original

This page is a summary of: Proton pump inhibitors and risk of hip fracture: a meta-analysis of observational studies, Osteoporosis International, December 2018, Springer Science + Business Media,
DOI: 10.1007/s00198-018-4788-y.
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