Chipping Away at Bone: Proton-Pump Inhibitors and Smoking
Long-term PPI use was associated with excess risk for postmenopausal hip fractures, especially in smokers.
Proton-pump inhibitors (PPIs) suppress gastric acid production and, consequently, calcium absorption. Thus, long-term PPI use may reduce bone density and raise fracture risk. Using data from the Nurses' Health Study (NHS) and prior studies, investigators assessed the association between long-term PPI use and risk for hip fracture in postmenopausal women.
Among 80,000 women in the NHS (age range at entry, 30–55), PPI use rose from 7% in 2000 to 19% in 2008. Absolute risk for hip fracture was 2.0 events per 1000 person-years among regular PPI users and 1.5 events per 1000 person-years among nonusers. Adjusted for multiple factors (e.g., body-mass index, calcium intake, osteoporosis history, use of hormone therapy), risk for hip fracture among women who used PPIs regularly for 2 years was 40% higher than among nonusers and rose with duration of PPI use. Among previous or current smokers, PPI use was associated with a 50% increased risk for hip fracture, whereas among never-smokers, PPI use was not associated with excess risk. In a meta-analysis involving 11 studies and 1.5 million participants, PPI use was associated with a 30% increased risk for hip fracture.
Notably, proton-pump inhibitor use also has been associated with excess risks for vertebral, forearm, and wrist fractures. The finding that chronic PPI use is associated with excess risk for hip fracture, especially in women with histories of smoking, suggests that long-term PPI use in women should be critically evaluated.
Paul S. Mueller, MD, MPH, FACP
Published in Journal Watch General Medicine February 14, 2012
Citation(s): Khalili H et al. Use of proton pump inhibitors and risk of hip fracture in relation to dietary and lifestyle factors: A prospective cohort study. BMJ 2012 Jan 31; 344:e372. http://dx.doi.org/10.1136/bmj.e372