Long-term Proton Pump Inhibitor Therapy and Risk of Hip Fracture

Yu, Yang; Lewis, James D.; Epstein, Solomon; Metz, David C.

doi:10.1001/jama.296.24.2947

Cited by 1,067 publications

(816 citation statements)

References 39 publications

Supporting

Mentioning

742

Contrasting

Unclassified

Order By: Relevance

“…• une étude cas-témoin britannique nichée dans la cohorte General Practice Research Database (GPRD) [4], qui a conclu qu'une durée de traitement par IPP supérieure à une année était associée à un risque augmenté de fracture du col du fémur. [6].…”

Section: Risque Fracturaireunclassified

See 1 more Smart Citation

Effets indésirables des inhibiteurs de la pompe à proton : faut-il craindre de les prescrire au long cours ?

Roulet

Vernaz

Giostra

et al. 2012

La Revue de Médecine Interne

View full text Add to dashboard Cite

Mots clés :Inhibiteurs de la pompe à proton Fractures ostéoporotiques Infections Cancer gastrique Pharmacodépendance r é s u m é La prévalence des traitements de longue durée par inhibiteurs de la pompe à proton (IPP) est en augmentation. Si leur tolérance à court terme est bonne, des réserves ont vu le jour sur d'éventuels effets indésirables graves associés à une exposition prolongée. Ainsi, l'association avec le risque fracturaire semble être confirmée, notamment au niveau vertébral, ainsi que le risque d'effet rebond sur la sécrétion acide à l'arrêt du traitement. Le risque de pneumopathie communautaire n'est pas établi dans la population générale et semble limité aux patients les plus fragiles. L'association avec le risque d'infection digestive à Clostridium difficile est probable. Les cas de néphrite tubulo-intestitielle sont rares mais peuvent conduire à une insuffisance rénale chronique. Les données disponibles sont encore insuffisantes pour évaluer le risque de carence en vitamine B12, en fer ou en magnésium et le risque de cancer digestif, même si des bases physiopathologiques existent dans le cas du cancer gastrique. Il existe des interactions avec de nombreux autres médicaments, notamment ceux qui sont métabolisés par certaines isoenzymes du cytochrome P450. Enfin, la balance bénéfice-risque de l'utilisation des IPP au long cours chez l'enfant semble défavorable dans la plupart des cas.© 2012 Société nationale française de médecine interne (SNFMI). Publié par Elsevier Masson SAS. Tous droits réservés. Keywords: Proton pump inhibitors Osteoporotic fractures Infection Stomach neoplasms Substance withdrawal syndrome a b s t r a c tLong-term treatment with proton pump inhibitors (PPI) is becoming more prevalent. Although they are well tolerated in the short term, serious concerns about long-term use have arisen. Recent data suggest that the latter is associated with an increased risk for osteoporotic fracture (especially vertebral), Clostridium difficile infection and rebound acid hypersecretion after treatment discontinuation. Acute interstitial nephritis is rare but may progress to chronic renal failure. An increased risk of communityacquired pneumonia has not been established in the general population and seems limited to the most vulnerable patients. Consistent data are still missing to correctly assess the risk of iron deficiency, vitamin B12 deficiency or hypomagnesaemia and the risk of digestive malignant diseases, despite the pathophysiological basis that exists concerning gastric malignancy. Many drug interactions can occur on long-term treatment, including some that imply the cytochrome P450 enzymes. Finally, the risk-benefit balance for a chronic PPI use in children seems unfavorable in most cases.

show abstract

Section: Risque Fracturaireunclassified

“…Plusieurs auteurs en ont déduit que ces fractures relevaient d'un mécanisme ostéoporotique [4,5]. Pourtant, une étude réalisée chez des volontaires sains et utilisant une mesure directe de l'absorption intestinale du calcium a montré que l'oméprazole ne modifiait pas cette absorption [10].…”

Section: Risque Fracturaireunclassified

Effets indésirables des inhibiteurs de la pompe à proton : faut-il craindre de les prescrire au long cours ?

Roulet

Vernaz

Giostra

et al. 2012

La Revue de Médecine Interne

View full text Add to dashboard Cite

show abstract

“…(1,2) PPIs specifically target the H þ ,K þ -ATPase pump of the gastric parietal cell, thereby inhibiting the final step in gastric acid production. An emerging concern about chronic PPI therapy is that it may inhibit intestinal calcium absorption.…”

Section: Introductionmentioning

confidence: 99%

“…Concerns about the effects of PPIs on calcium homeostasis have been heightened by two retrospective case-controlled studies that reported an increased risk of fracture in patients with long term PPI use. (1,3) A recent prospective study in 1211 postmenopausal women found that omeprazole use was associated with an increased risk of vertebral fractures. (4) Another study, however, failed to find such an association.…”

Section: Introductionmentioning

confidence: 99%

Inhibiting gastric acid production does not affect intestinal calcium absorption in young, healthy individuals: A randomized, crossover, controlled clinical trial

Wright

Sullivan

Gaffney‐Stomberg

et al. 2010

Journal of Bone and Mineral Research

View full text Add to dashboard Cite

Proton pump inhibitors (PPIs) are the most potent gastric acid suppressing drugs available, and their use is widespread. An emerging concern about chronic PPI therapy is whether these drugs impair intestinal calcium absorption, resulting in a negative calcium balance and thereby potentially causing bone loss. The objective of this study was to evaluate the acute effect of the PPI esomeprazole or placebo on intestinal calcium absorption in healthy adults. Twelve young adults participated in a placebo-controlled, double-blind, crossover study. There were two 3-week interventions that included a 14-day adjustment period (designed to stabilize calcium homeostasis) followed by 6 days of a diet containing 800 mg of calcium and 2.1 g/kg of protein (intervention). During the last 3 days of the adjustment period and throughout the intervention period, subjects consumed esomeprazole or placebo. Half the subjects underwent 24-hour continuous gastric acid pH monitoring. Intestinal calcium absorption was measured using dual-stable calcium isotopes at the end of each intervention. Treatment with esomprazole significantly increased gastric pH (mean pH on PPI 5.38 AE 0.13, mean pH on placebo 2.70 AE 0.44, p ¼ .005). Neither calcium absorption (PPI 34.2% AE 2.4%, placebo 31.5% AE 2.1%, p ¼ .24) nor urinary calcium (PPI 321 AE 38 mg/34 hours, placebo 355 AE 37 mg/34 hours, p ¼ .07) differed between the PPI and placebo groups. It is concluded that short-term gastric acid suppression by PPIs does not attenuate intestinal calcium absorption in healthy young adults. ß

show abstract

“…Many retrospective observational studies found several adverse outcomes linked to PPI therapy, including hip fracture,6 pneumonia,7 acute interstitial nephritis8 and hypomagnesemia 9. Thus, the safety of the long‐term use of PPI has recently been questioned.…”

mentioning

confidence: 99%

Proton pump inhibitors and risk of periampullary cancers—A nested case–control study

Chien

Huang

Shao

et al. 2015

Intl Journal of Cancer

View full text Add to dashboard Cite

Considerable attention has been focused on long‐term use of proton pump inhibitor (PPI) medications in relation to increased risk of cancer via stimulation of DNA‐damaged cells. The aim of this study is to examine the dose‐dependent effect of PPI on periampullary cancers in a national population‐based cohort. A nested case–control analysis was constructed based on Taiwan's National Health Insurance Research Database and the Taiwan Cancer Registry between the years 2000 and 2010. Cases involving patients diagnosed with periampullary cancers were selected and controls were matched to cases according to age, sex and observational period. A “PPI user” was defined as any patient receiving more than 28 cumulative defined daily doses as measured by prescription drug claims. Conditional logistic regression analysis was conducted to calculate odds ratios (ORs) and 95% confidence intervals (CIs) according to the level of PPI exposure. A total of 7,681 cases and 76,762 matched controls were included with a mean follow‐up period of 6.6 years (SD: 2.0). The odds of PPI exposure in patients with periampullary cancers were higher than that of control patients with an adjusted OR of 1.35 (95% CIs: 1.16–1.57). Our results also showed that PPI exposure was slightly linked to periampullary cancers in dose‐dependent manner. A similar association was observed in patients who solely took PPI but no eradication therapy for Helicobacter pylori infection. Long‐term PPI use was associated with an increased risk of periampullary cancers in the current population‐based study. Physicians must weigh potential risks of long‐term maintenance against therapeutic benefit.

show abstract

Long-term Proton Pump Inhibitor Therapy and Risk of Hip Fracture

Cited by 1,067 publications

References 39 publications

Effets indésirables des inhibiteurs de la pompe à proton : faut-il craindre de les prescrire au long cours ?

Effets indésirables des inhibiteurs de la pompe à proton : faut-il craindre de les prescrire au long cours ?

Inhibiting gastric acid production does not affect intestinal calcium absorption in young, healthy individuals: A randomized, crossover, controlled clinical trial

Proton pump inhibitors and risk of periampullary cancers—A nested case–control study

Contact Info

Product

Resources

About