Fracture Risk and Bone Mineral Density Reduction Associated with Proton Pump Inhibitors

Yuen Ting Lau, Pharm.D.; Nasiya N. Ahmed, M.D.

Disclosures

Pharmacotherapy. 2012;32(1):67-79. 

In This Article

Future Research

Since patient characteristics may influence the risk of fracture associated with PPIs, future studies should evaluate the impact of prolonged PPI use in high-risk populations. With a few exceptions,[6,8,11,13] the current studies included many patients who were older than 70 years and had multiple comorbidities. These characteristics of study subjects match those of the general population that is at risk for osteoporotic fracture; however, most studies excluded patients with prior hip fracture or osteoporosis, which are important risk factors for hip fracture.[22,40] Concurrent use of bisphosphonates was evaluated in two studies, results of which showed attenuation of the benefit of bisphosphonates by PPIs.[15] In contrast, bisphosphonates could not attenuate the risk of fracture associated with PPIs.[17] The risk of fracture associated with PPIs in patients with osteoporosis, with a history of hip fracture, or taking antiresorptive therapy may be different than that in the studied population. Furthermore, based on the studies comparing current PPI users with past PPI users, the risk of fracture associated with PPIs may return to baseline after discontinuation of the agents.[7,16,17] As a result, future studies should evaluate the risk of fracture associated with continuous PPI use.

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