Long-term PPI use does not pose increased fracture risk
Proton pump inhibitor (PPI) therapy does not contribute to increased risk of fractures, with a new study suggesting that its long-term use has no effect on bone mineral density (BMD) or bone strength.
Researchers looked at 52 long-term (≥5 years) PPI users and 52 individuals who had no PPI exposure in the previous 5 years to determine if long-term PPI induced structural changes in bone independent of areal BMD.
Assessments of areal BMD, volumetric BMD and markers of bone metabolism were performed using dual photon X-ray absorptiometry and three-dimensional quantitative computed tomography. Measures of bone strength such as buckling ratio and section modulus were examined and compared between the groups of PPI users and nonusers.
The results for standard BMD, volumetric BMD and markers of bone mineral density did not differ significantly between the PPI and non-PPI groups.
Likewise, there were no significant between-group differences observed in the measures of bone strength.
The findings show that there is no association between long-term PPI use and any changes in BMD or bone strength that may predispose users to an increased fracture risk.
Researchers said the data provided further evidence that the association between PPI use and fracture was not causal.
Osteoporosis occurs more frequently in women than men, with osteoporotic fractures being associated with significant morbidity and mortality. These fractures translate to high costs, in terms of healthcare costs and lost wages. Multiple medications—including corticosteroids, selective serotonin reuptake inhibitors, anticonvulsants, thiazolinediones, aromatase inhibitors and antiandrogen therapies—have been implicated as contributing to increased risk of fragility fractures. [Osteoporos Int 2013;24:1161–1168]