Barret’s oesophagus, PPI use do not pose increased fracture risk
Barret’s oesophagus patients do not appear to be at greater risk of osteoporotic fractures compared with the general population, according to a study. Moreover, the use of proton pump inhibitors (PPI) does not contribute to an increased risk regardless of the duration of therapy or dosing strategy.
The study drew data from the Rochester Epidemiology Project resources and included 521 Barret’s oesophagus patients (median age 61 years; 76 percent male). The incidence rates of all and osteoporotic fractures in these patients were evaluated against the incident rates in an age- and gender-matched population in the Olmsted County.
Of the patients, 21.7 percent had fractures and 8.8 percent had osteoporotic fractures. The incidence of all fractures and osteoporotic fractures was comparable to that in the Olmsted population (standard incidence ratio [SIR] of all fractures, 1.09; 95 percent CI, 0.92 to 1.29: SIR of osteoporotic fractures, 1.05; 0.85 to 1.29).
PPI dose or duration of use was not related to osteoporotic fracture risk (hazard ratio, 0.87; 0.12 to 6.39). On Cox proportional analysis, older age, female gender and higher comorbidity index emerged as independent risk factors for osteoporotic fractures.
The present data suggest that Barret’s oesophagus patients who are on chronic PPI therapy are not at increased risk of developing subsequent fractures (from any aetiology or secondary to low bone mass) relative to the general population, researchers said.
Potential mechanisms by which PPI might affect skeletal integrity include altered bone remodelling, decreased intestinal calcium absorption and negative overall body calcium balance, all ultimately leading to increased fracture risk. [Current Drug Safety 2008;3:204-209; Am J Med 2005;118:778-781]