A recently published meta-analysis of the association of long term use of anti-acid suppressive medication with an increased risk of fractures reported that acid-suppressive medications were associated with increased risk of fracture, especially hip fracture.
Cai, Feng and Jiang (2015) reported “We found that 1-3 year’s exposure of PPI was more strongly related to hip fracture risk (1.225, 1.137-1.319) than less than 1 year (1.191, 1.111-1.278). Exposure of more than 5 years was related to even higher risk of fracture. However, the risk of hip fracture for >3 year of PPI use was slightly lower than those for 1-3 year of exposure”
Acid-suppressive medications and risk of fracture: an updated meta-analysis
Acid-suppressive medications are widely used for the management of acid-related disorders. It has been reported that acid-suppressive medication users were at increased risk of fracture, but such an association was inconsistent among observational studies. The purpose of our analysis was to assess the relationship between use of antacid drugs and fracture risk.
We systematically searched electronic database and manually examined the reference lists of previous reviews for potentially eligible studies. Given the heterogeneity across studies, random effects models were used to calculate summary estimates. Subgroup analysis and sensitivity analysis were conducted to explore the potential heterogeneity.
18 studies met our inclusion criteria. PPI and H2RA were associated with increased risk of hip fracture, with substantial heterogeneity (PPI: 1.216, 1.134-1.304, I(2)=71.3%; H2RA: 1.128, 1.022-1.245, I(2)=72.1%). High risk of spine fracture was observed in PPI users (1.216, 95% CI: 1.134-1.304) but not H2RA users. When considering 5 studies conducted among postmenopausal women, the RR was 1.376, (95% CI: 1.043-1.816) with modest heterogeneity (I(2)=57.7%). Subgroup analysis and sensitivity analysis found consistent association between hip fracture risk and PPI use but not H2RA use. Positive association for H2RA use lost its significance when considering case-control studies and European studies.
Results of this updated meta-analysis provided evidence to support that acid-suppressive medications were associated with increased risk of fracture, especially hip fracture.