Use PPIs with caution in patients at high risk of hip fractures

As per a meta-analysis of observational studies reported online Dec. 12, 2018 in the journal Osteoporosis International, proton pump inhibitors (PPIs) are significantly associated with an increased risk of hip fracture. This effect is not seen with histamine 2 receptor antagonists (H2RAs).

The meta-analysis included 24 observational studies with 2,103,800 participants. Of these, 319,568 were hip fracture patients. Analysis showed that patients on PPIs had a greater risk of hip fracture than those who were not on PPI (risk ratio 1.20; p < 0.0001).

The risk increased with the dose of PPIs. The observed risk was high for both low and medium doses of PPIs and it was even greater for patients taking high dose PPIs; low dose RR 1.17 (p = 0.002); medium dose RR 1.28 (p <0.0001) and higher dose RR 1.30 (p <0.0001).

But no association was found between the use of H2RAs and increased risk of hip fracture.

The study recommends cautious prescription of PPIs, especially long-term and higher dose PPIs, in patients who are at high risk of hip fracture. The authors further say that “patients should be concerned about the inappropriate use of PPIs; if necessary, then, they should continue to receive it with a clear indication”.

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