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Hip Fracture Risk Higher in Older Women on Proton Pump Inhibitors

Jun 8, 2011 | Parker Waichman LLP

A study presented last month at the annual Digestive Disease Week in Chicago has confirmed that long-term use of proton pump inhibitors, such as Nexium, increases the risk of hip fractures in post-menopausal women.  According to Internal Medicine News, the study also found that the hip fracture risk  was higher among women who used the popular heart burn drugs, even when adjusting for other risk factors including vitamin D intake; history of osteoporosis; and use of hormone replacement therapy, bisphosphonates, and thiazides. 

Previous smaller studies indicating that long-term use of proton pump inhibitors increased fracture risk in this patient population prompted the U.S. Food & Drug Administration to add warnings to their labels last year.  But according to Internal Medicine News, other "analyses have mostly been based on retrospective studies of small populations that have not controlled for important dietary and lifestyle confounders." The authors of this new study, which involved 79,899 postmenopausal women enrolled in the Nurses’ Health Study, wanted to reach a more definitive conclusion by "prospectively examining the relationship between chronic PPI use and incident hip fracture."

The women in the study were first asked about fractures in 1982, and were followed up about new fractures on a biennial basis.  According to the study authors, there were 893 incident hip fractures over 8 years. Proton pump inhibitor use was reported by 7% of participants in 2000 and by 19% of participants in 2008.

According to Internal Medicine News, the researchers found that:

  • In comparing the risk of hip fractures in women who took proton pump inhibitors versus those who did not, the risk for those taking the drugs rose to 6% after 2 years of use, 42% after 4 years and 54% when proton pump inhibitors were used for 6 years or longer. 
  • Regular use of drugs posed fracture risks of 35%-45% when adjusted for age, calcium intake, and body mass index.
  • Discontinuing use of the drugs reduced fracture risk.  Two or more years after discontinuation, the risk of hip fracture was just 9%-10%.
  • Of the other risk factors taken into account, only smoking had any impact.  Current or past smokers and who regularly took a proton pump inhibitors had a 51% increased risk for fracture, compared to 6% in nonsmokers.

According to Internal Medicine News, the study was received well at the Digestive Disease Week conference, with attendees calling it "truly excellent work" and "impressive."

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