Long-term use of indigestion drugs may increase hip fracture risk

By Lilian Anekwe

BMJ Group News

What do we know already?

Proton pump inhibitors (PPIs) are drugs that are often taken by people who have gastro-oesophageal reflux disease (GORD), sometimes called heartburn. This is when you have an uncomfortable burning feeling caused by acid from your stomach flowing up into your oesophagus, the tube that carries food from your mouth to your stomach.

PPIs ease the symptoms of GORD by reducing the amount of acid your stomach makes. Some common PPIs are omeprazole (Losec), lansoprazole (Zoton), rabeprazole (Pariet), pantoprazole (Protium, Pantoloc Control), and esomeprazole (Nexium).

There are concerns that taking PPIs could increase the risk of bone fractures. This is because they can prevent your bones from absorbing calcium. There have been several studies to look into this but the results have been conflicting and the evidence is not clear.

This study included nearly 80,000 women who were aged between 30 and 55 in 1976. They answered questionnaires every two years about their health, if they had fractured their hip, and whether they regularly took any drugs for GORD. The researchers compared how likely women who took PPIs were to have had a hip fracture, compared with women who didn’t take PPIs.

What does the new study say?

The overall numbers of hip fractures was low. There were 893 hip fractures recorded in 79,899 women in the study.

Amongst women who had ever regularly taken a PPI at any time, two fractured a hip for every thousand women in the study each year, and the same number of women fractured a hip if they didn’t take PPIs.

But women who regularly took PPIs for at least two years were 35 percent more likely to have had a hip fracture compared with those who didn’t.

This risk was even higher if women smoked. These women were 51 percent more likely to have had a hip fracture. The researchers say smoking might interfere with the body’s ability to absorb calcium, and so might make your bones weaker than they should be and more likely to fracture.

Women who had stopped taking PPIs for more than two years lowered their risk to a level similar to women who had never taken them.

The risk of a fracture was also higher in women who took PPIs compared to those who took a different type of drug for indigestion, called H2 blockers. The risk in women who took PPIs was 23 percent higher than women who took H2 blockers.