Letter: proton pump inhibitor use and bone fracture risk—a mechanistic point of view. Authors' reply

Abstract

LINKED CONTENTThis article is linked to Labenz et al and Sugiyama papers. To view these articles, visit https://doi.org/10.1111/apt.16008 and https://doi.org/10.1111/apt.16231

The impact of proton pump inhibitors in liver diseases and the effects on the liver

“…The effect of PPIs on fracture in patients with cirrhosis may be multifactorial, since PPIs may increase the risk of falls by triggering mild HE and converting it to overt hepatic encephalopathy (OHE), which in turn increases the risk of fracture. However, the authors were unable to adjust for this factor 118 . Therefore, the effect of PPIs on fracture risk in patients with cirrhosis remains to be clarified.…”

“…In a population-based study, PPIs were found to be associated with an increased risk of bone fracture in cirrhotic patients (OR 1.34, 95% CI 1.20-1.51), indicating that such association was dose-dependent and most significant in patients under 70 years old and in men. 116 Sugiyama 118 has noted that this may be a mechanistic view resulting from the retrospective study design as PPIs have a slight effect on the risk of falls and no effect on bone mineral density and structure, which are associated with a risk of fracture in cirrhotic patients. 117 The effect of PPIs on fracture in patients with cirrhosis may be multifactorial, since PPIs may increase the risk of falls by triggering mild HE and converting it to overt hepatic encephalopathy (OHE), which in turn increases the risk of fracture.…”

“…However, the authors were unable to adjust for this factor. 118 Therefore, the effect of PPIs on fracture risk in patients with cirrhosis remains to be clarified.…”