Proton pump inhibitors and risk of hip fracture: a meta-analysis of observational studies
Summary We performed a meta-analysis of relevant studies to quantify the magnitude of the association between proton pump inhibitors (PPIs) and risk of hip fracture. Patients with PPIs had a greater risk of hip fracture than those without PPI therapy (RR 1.20, 95% CI 1.14–1.28, p
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| creator | Poly, T.N. Islam, M.M. Yang, H.-C. Wu, C.C. Li, Y.-C.(.J.). |
| description | Summary
We performed a meta-analysis of relevant studies to quantify the magnitude of the association between proton pump inhibitors (PPIs) and risk of hip fracture. Patients with PPIs had a greater risk of hip fracture than those without PPI therapy (RR 1.20, 95% CI 1.14–1.28,
p
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| doi_str_mv | 10.1007/s00198-018-4788-y |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_journals_2154456043</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2154456043</sourcerecordid><originalsourceid>FETCH-LOGICAL-c372t-fcbb288b6e62342d5475e38449d3396a9a74a2e8df4b68a5e034c231cd45fe993</originalsourceid><addsrcrecordid>eNp1kE1LxDAURYMozjj6A9xIwHU0X20TdzL4BQO6UNBVSNvUyTjT1CQV-u_N0FFXrgIv5973OACcEnxBMC4uA8ZECoSJQLwQAg17YEo4Y4jKPNsHUyxZgSQnrxNwFMIKp4yUxSGYMJwxSQs6BW9P3kXXwq7fdNC2S1va6HyAuq2ht-EDugYubQcbr6vYe3MFNdyYqJFu9XoINmwBVwbjv3S0Lg1hiH1tTTgGB41eB3Oye2fg5fbmeX6PFo93D_PrBapYQSNqqrKkQpS5ySnjtM54kRkmOJc1YzLXUhdcUyPqhpe50JnBjFeUkarmWWOkZDNwPvZ23n32JkS1cr1PhwRFScZ5luOkZAbISFXeheBNozpvN9oPimC1lalGmSrJVFuZakiZs11zX25M_Zv4sZcAOgIhfbXvxv-t_r_1G07qgG8</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2154456043</pqid></control><display><type>article</type><title>Proton pump inhibitors and risk of hip fracture: a meta-analysis of observational studies</title><source>MEDLINE</source><source>Springer Nature - Complete Springer Journals</source><creator>Poly, T.N. ; Islam, M.M. ; Yang, H.-C. ; Wu, C.C. ; Li, Y.-C.(.J.).</creator><creatorcontrib>Poly, T.N. ; Islam, M.M. ; Yang, H.-C. ; Wu, C.C. ; Li, Y.-C.(.J.).</creatorcontrib><description><![CDATA[Summary
We performed a meta-analysis of relevant studies to quantify the magnitude of the association between proton pump inhibitors (PPIs) and risk of hip fracture. Patients with PPIs had a greater risk of hip fracture than those without PPI therapy (RR 1.20, 95% CI 1.14–1.28,
p
< 0.0001). These results could be taken into consideration with caution, and patients should also be concerned about the inappropriate use of PPIs.
Introduction
Proton pump inhibitors (PPIs) are generally considered as first-line medicine with great safety profile, commonly prescribed for gastroesophageal reflux disease (GERD) and peptic ulcer disease. However, several epidemiological studies documented that long-term use of PPIs may be associated with an increased risk of hip fracture. Although, the optimal magnitude of the hip fracture risk is still undetermined. We, therefore, performed a meta-analysis of relevant studies to quantify the magnitude of the association between PPIs and risk of hip fracture.
Methods
We collected relevant articles using MEDLINE, EMBASE, Google Scholar, and Web of Science from January 1, 1990, to March 31, 2018. We included only the large (
n
≥ 500) observational studies with a follow-up duration of at least one year in which the hip fracture patients were identified by a standard procedure. Two of the authors extracted data from each included study independently according to a standardized protocol.
Results
A total of 24 observational studies with 2,103,800 participants (319,568 hip fracture patients) met all the eligibility criteria. Patients with PPIs had a greater risk of hip fracture than those without PPI therapy (RR 1.20, 95% CI 1.14–1.28,
p
< 0.0001). An increased association was also observed in both low and medium doses of PPI taken and hip fracture risk (RR 1.17, 95% CI 1.05–1.29,
p
= 0.002; RR 1.28, 95% CI 1.14–1.44,
p
< 0.0001), but it appeared to be even greater among the patients with higher dose (RR 1.30, 95% CI 1.20–1.40,
p
< 0.0001). Moreover, the overall pooled risk ratios were 1.20 (95% CI 1.15–1.25,
p
< 0.0001) and 1.24 (95% CI 1.10–1.40,
p
< 0.0001) for the patients with short- and long-term PPI therapy, respectively, compared with PPI non-users.
Conclusion
Our results suggest that PPI use is significantly associated with an increased risk of hip fracture development, which is not observed in H2RA exposure. Physicians should, therefore, exercise caution when considering a long-term PPI treatment to their patients who already have an elevated risk of hip fracture. In addition, patients should be concerned about the inappropriate use of PPIs; if necessary, then, they should continue to receive it with a clear indication.]]></description><identifier>ISSN: 0937-941X</identifier><identifier>EISSN: 1433-2965</identifier><identifier>DOI: 10.1007/s00198-018-4788-y</identifier><identifier>PMID: 30539272</identifier><language>eng</language><publisher>London: Springer London</publisher><subject>Dose-Response Relationship, Drug ; Drug Administration Schedule ; Endocrinology ; Fractures ; Gastroesophageal reflux ; Health risk assessment ; Hip ; Hip Fractures - chemically induced ; Humans ; Medicine ; Medicine & Public Health ; Meta-analysis ; Observational studies ; Observational Studies as Topic ; Original Article ; Orthopedics ; Osteoporosis ; Osteoporotic Fractures - chemically induced ; Patients ; Proton pump inhibitors ; Proton Pump Inhibitors - administration & dosage ; Proton Pump Inhibitors - adverse effects ; Rheumatology ; Risk Assessment - methods</subject><ispartof>Osteoporosis international, 2019-01, Vol.30 (1), p.103-114</ispartof><rights>International Osteoporosis Foundation and National Osteoporosis Foundation 2018</rights><rights>Osteoporosis International is a copyright of Springer, (2018). All Rights Reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c372t-fcbb288b6e62342d5475e38449d3396a9a74a2e8df4b68a5e034c231cd45fe993</citedby><cites>FETCH-LOGICAL-c372t-fcbb288b6e62342d5475e38449d3396a9a74a2e8df4b68a5e034c231cd45fe993</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00198-018-4788-y$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00198-018-4788-y$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27903,27904,41467,42536,51298</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30539272$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Poly, T.N.</creatorcontrib><creatorcontrib>Islam, M.M.</creatorcontrib><creatorcontrib>Yang, H.-C.</creatorcontrib><creatorcontrib>Wu, C.C.</creatorcontrib><creatorcontrib>Li, Y.-C.(.J.).</creatorcontrib><title>Proton pump inhibitors and risk of hip fracture: a meta-analysis of observational studies</title><title>Osteoporosis international</title><addtitle>Osteoporos Int</addtitle><addtitle>Osteoporos Int</addtitle><description><![CDATA[Summary
We performed a meta-analysis of relevant studies to quantify the magnitude of the association between proton pump inhibitors (PPIs) and risk of hip fracture. Patients with PPIs had a greater risk of hip fracture than those without PPI therapy (RR 1.20, 95% CI 1.14–1.28,
p
< 0.0001). These results could be taken into consideration with caution, and patients should also be concerned about the inappropriate use of PPIs.
Introduction
Proton pump inhibitors (PPIs) are generally considered as first-line medicine with great safety profile, commonly prescribed for gastroesophageal reflux disease (GERD) and peptic ulcer disease. However, several epidemiological studies documented that long-term use of PPIs may be associated with an increased risk of hip fracture. Although, the optimal magnitude of the hip fracture risk is still undetermined. We, therefore, performed a meta-analysis of relevant studies to quantify the magnitude of the association between PPIs and risk of hip fracture.
Methods
We collected relevant articles using MEDLINE, EMBASE, Google Scholar, and Web of Science from January 1, 1990, to March 31, 2018. We included only the large (
n
≥ 500) observational studies with a follow-up duration of at least one year in which the hip fracture patients were identified by a standard procedure. Two of the authors extracted data from each included study independently according to a standardized protocol.
Results
A total of 24 observational studies with 2,103,800 participants (319,568 hip fracture patients) met all the eligibility criteria. Patients with PPIs had a greater risk of hip fracture than those without PPI therapy (RR 1.20, 95% CI 1.14–1.28,
p
< 0.0001). An increased association was also observed in both low and medium doses of PPI taken and hip fracture risk (RR 1.17, 95% CI 1.05–1.29,
p
= 0.002; RR 1.28, 95% CI 1.14–1.44,
p
< 0.0001), but it appeared to be even greater among the patients with higher dose (RR 1.30, 95% CI 1.20–1.40,
p
< 0.0001). Moreover, the overall pooled risk ratios were 1.20 (95% CI 1.15–1.25,
p
< 0.0001) and 1.24 (95% CI 1.10–1.40,
p
< 0.0001) for the patients with short- and long-term PPI therapy, respectively, compared with PPI non-users.
Conclusion
Our results suggest that PPI use is significantly associated with an increased risk of hip fracture development, which is not observed in H2RA exposure. Physicians should, therefore, exercise caution when considering a long-term PPI treatment to their patients who already have an elevated risk of hip fracture. In addition, patients should be concerned about the inappropriate use of PPIs; if necessary, then, they should continue to receive it with a clear indication.]]></description><subject>Dose-Response Relationship, Drug</subject><subject>Drug Administration Schedule</subject><subject>Endocrinology</subject><subject>Fractures</subject><subject>Gastroesophageal reflux</subject><subject>Health risk assessment</subject><subject>Hip</subject><subject>Hip Fractures - chemically induced</subject><subject>Humans</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Meta-analysis</subject><subject>Observational studies</subject><subject>Observational Studies as Topic</subject><subject>Original Article</subject><subject>Orthopedics</subject><subject>Osteoporosis</subject><subject>Osteoporotic Fractures - chemically induced</subject><subject>Patients</subject><subject>Proton pump inhibitors</subject><subject>Proton Pump Inhibitors - administration & dosage</subject><subject>Proton Pump Inhibitors - adverse effects</subject><subject>Rheumatology</subject><subject>Risk Assessment - methods</subject><issn>0937-941X</issn><issn>1433-2965</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp1kE1LxDAURYMozjj6A9xIwHU0X20TdzL4BQO6UNBVSNvUyTjT1CQV-u_N0FFXrgIv5973OACcEnxBMC4uA8ZECoSJQLwQAg17YEo4Y4jKPNsHUyxZgSQnrxNwFMIKp4yUxSGYMJwxSQs6BW9P3kXXwq7fdNC2S1va6HyAuq2ht-EDugYubQcbr6vYe3MFNdyYqJFu9XoINmwBVwbjv3S0Lg1hiH1tTTgGB41eB3Oye2fg5fbmeX6PFo93D_PrBapYQSNqqrKkQpS5ySnjtM54kRkmOJc1YzLXUhdcUyPqhpe50JnBjFeUkarmWWOkZDNwPvZ23n32JkS1cr1PhwRFScZ5luOkZAbISFXeheBNozpvN9oPimC1lalGmSrJVFuZakiZs11zX25M_Zv4sZcAOgIhfbXvxv-t_r_1G07qgG8</recordid><startdate>20190101</startdate><enddate>20190101</enddate><creator>Poly, T.N.</creator><creator>Islam, M.M.</creator><creator>Yang, H.-C.</creator><creator>Wu, C.C.</creator><creator>Li, Y.-C.(.J.).</creator><general>Springer London</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QP</scope><scope>7RV</scope><scope>7TS</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope></search><sort><creationdate>20190101</creationdate><title>Proton pump inhibitors and risk of hip fracture: a meta-analysis of observational studies</title><author>Poly, T.N. ; Islam, M.M. ; Yang, H.-C. ; Wu, C.C. ; Li, Y.-C.(.J.).</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c372t-fcbb288b6e62342d5475e38449d3396a9a74a2e8df4b68a5e034c231cd45fe993</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Dose-Response Relationship, Drug</topic><topic>Drug Administration Schedule</topic><topic>Endocrinology</topic><topic>Fractures</topic><topic>Gastroesophageal reflux</topic><topic>Health risk assessment</topic><topic>Hip</topic><topic>Hip Fractures - chemically induced</topic><topic>Humans</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Meta-analysis</topic><topic>Observational studies</topic><topic>Observational Studies as Topic</topic><topic>Original Article</topic><topic>Orthopedics</topic><topic>Osteoporosis</topic><topic>Osteoporotic Fractures - chemically induced</topic><topic>Patients</topic><topic>Proton pump inhibitors</topic><topic>Proton Pump Inhibitors - administration & dosage</topic><topic>Proton Pump Inhibitors - adverse effects</topic><topic>Rheumatology</topic><topic>Risk Assessment - methods</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Poly, T.N.</creatorcontrib><creatorcontrib>Islam, M.M.</creatorcontrib><creatorcontrib>Yang, H.-C.</creatorcontrib><creatorcontrib>Wu, C.C.</creatorcontrib><creatorcontrib>Li, Y.-C.(.J.).</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>Proquest Nursing & Allied Health Source</collection><collection>Physical Education Index</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Public Health Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><jtitle>Osteoporosis international</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Poly, T.N.</au><au>Islam, M.M.</au><au>Yang, H.-C.</au><au>Wu, C.C.</au><au>Li, Y.-C.(.J.).</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Proton pump inhibitors and risk of hip fracture: a meta-analysis of observational studies</atitle><jtitle>Osteoporosis international</jtitle><stitle>Osteoporos Int</stitle><addtitle>Osteoporos Int</addtitle><date>2019-01-01</date><risdate>2019</risdate><volume>30</volume><issue>1</issue><spage>103</spage><epage>114</epage><pages>103-114</pages><issn>0937-941X</issn><eissn>1433-2965</eissn><abstract><![CDATA[Summary
We performed a meta-analysis of relevant studies to quantify the magnitude of the association between proton pump inhibitors (PPIs) and risk of hip fracture. Patients with PPIs had a greater risk of hip fracture than those without PPI therapy (RR 1.20, 95% CI 1.14–1.28,
p
< 0.0001). These results could be taken into consideration with caution, and patients should also be concerned about the inappropriate use of PPIs.
Introduction
Proton pump inhibitors (PPIs) are generally considered as first-line medicine with great safety profile, commonly prescribed for gastroesophageal reflux disease (GERD) and peptic ulcer disease. However, several epidemiological studies documented that long-term use of PPIs may be associated with an increased risk of hip fracture. Although, the optimal magnitude of the hip fracture risk is still undetermined. We, therefore, performed a meta-analysis of relevant studies to quantify the magnitude of the association between PPIs and risk of hip fracture.
Methods
We collected relevant articles using MEDLINE, EMBASE, Google Scholar, and Web of Science from January 1, 1990, to March 31, 2018. We included only the large (
n
≥ 500) observational studies with a follow-up duration of at least one year in which the hip fracture patients were identified by a standard procedure. Two of the authors extracted data from each included study independently according to a standardized protocol.
Results
A total of 24 observational studies with 2,103,800 participants (319,568 hip fracture patients) met all the eligibility criteria. Patients with PPIs had a greater risk of hip fracture than those without PPI therapy (RR 1.20, 95% CI 1.14–1.28,
p
< 0.0001). An increased association was also observed in both low and medium doses of PPI taken and hip fracture risk (RR 1.17, 95% CI 1.05–1.29,
p
= 0.002; RR 1.28, 95% CI 1.14–1.44,
p
< 0.0001), but it appeared to be even greater among the patients with higher dose (RR 1.30, 95% CI 1.20–1.40,
p
< 0.0001). Moreover, the overall pooled risk ratios were 1.20 (95% CI 1.15–1.25,
p
< 0.0001) and 1.24 (95% CI 1.10–1.40,
p
< 0.0001) for the patients with short- and long-term PPI therapy, respectively, compared with PPI non-users.
Conclusion
Our results suggest that PPI use is significantly associated with an increased risk of hip fracture development, which is not observed in H2RA exposure. Physicians should, therefore, exercise caution when considering a long-term PPI treatment to their patients who already have an elevated risk of hip fracture. In addition, patients should be concerned about the inappropriate use of PPIs; if necessary, then, they should continue to receive it with a clear indication.]]></abstract><cop>London</cop><pub>Springer London</pub><pmid>30539272</pmid><doi>10.1007/s00198-018-4788-y</doi><tpages>12</tpages></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0937-941X |
| ispartof | Osteoporosis international, 2019-01, Vol.30 (1), p.103-114 |
| issn | 0937-941X 1433-2965 |
| language | eng |
| recordid | cdi_proquest_journals_2154456043 |
| source | MEDLINE; Springer Nature - Complete Springer Journals |
| subjects | Dose-Response Relationship, Drug Drug Administration Schedule Endocrinology Fractures Gastroesophageal reflux Health risk assessment Hip Hip Fractures - chemically induced Humans Medicine Medicine & Public Health Meta-analysis Observational studies Observational Studies as Topic Original Article Orthopedics Osteoporosis Osteoporotic Fractures - chemically induced Patients Proton pump inhibitors Proton Pump Inhibitors - administration & dosage Proton Pump Inhibitors - adverse effects Rheumatology Risk Assessment - methods |
| title | Proton pump inhibitors and risk of hip fracture: a meta-analysis of observational studies |
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