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Proton pump inhibitors (PPIs) and fracture risk

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

There is epidemiological evidence of an increased risk of fracture with long-term use of PPIs (1,2,3,4)

  • observational studies on a risk of fracture associated with PPIs suggest there may be a modest increase in the risk of hip, wrist, or spine fracture, especially if PPIs are used in high doses and over long durations (>1 year)
    • increased risk was observed mainly in elderly patients, and it is possible that other risk factors contribute to the increase in risk (2)
  • meta-analyses of published pharmacoepidemiology studies suggest the risk of fracture is increased by 10-40% above baseline (3)
  • a systematic review suggests a modest increase in the risk of hip fracture and vertebral fracture associated with PPIs, although some studies showed conflicting result (4)
    • three studies evaluated the risk of BMD reduction associated with PPIs but did not find consistent changes in baseline or subsequent BMD

The MHR advise that healthcare professionals should:

  • treat patients at risk of osteoporosis according to current clinical guidelines and ensure they have an adequate intake of vitamin D and calcium
  • take into account any use of PPIs obtained over-the-counter

People over the age of 50 taking PPIs may be considered for fracture-risk assessment, particularly in the presence of other risk factors (5)

Reference:


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