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Fracture risk in patients receiving acid-suppressant medication alone and in combination with bisphosphonates

Fracture risk in patients receiving acid-suppressant medication alone and in combination with bisphosphonates
Fracture risk in patients receiving acid-suppressant medication alone and in combination with bisphosphonates
Summary: previous studies have found an association between acid suppressants and fracture risk. We assessed fracture risk in patients taking concomitant acid suppressant and bisphosphonates. Positive associations were observed for any hip and vertebral fracture. The effect size was modest; however, the significance lies in the widespread prescribing of acid suppressants.
Introduction: previous studies have found that acid-suppressive medication (ASM) is associated with an increased risk of fracture. Bisphosphonates can cause upper gastrointestinal problems, and patients may be prescribed ASM to minimise these effects.
Methods: a retrospective cohort study using the GPRD was conducted in patients aged 40 years and older starting proton pump inhibitors (PPI, N?=?234,144), H2 receptor antagonists (H2RA, N?=?166,798) or bisphosphonates (N?=?67,309). Fracture risk in current versus past use of ASM and concomitant use of bisphosphonate plus ASM versus bisphosphonate alone was compared using time-dependent Cox regression.
Results: in the 6 months before initiating bisphosphonate therapy, 20.1% of patients received a PPI and 7.5% an H2RA. Current PPI use was associated with an increased risk of any (adjusted relative rate (ARR) 1.15, 95% CI 1.10–1.20), hip (ARR 1.22, 95% CI 1.10–1.37), and vertebral fracture (ARR 1.40, 95% CI 1.11–1.78); and concomitant bisphosphonates and PPIs with an increased risk of any (ARR 1.08, 95% CI 1.01–1.16) and hip fracture (ARR 1.24, 95% CI 1.08–1.42).
Conclusions: ASM is associated with an increased risk of fracture when taken alone or in combination with bisphosphonates. Given the frequency of coprescription of ASM and bisphosphonates, this issue requires further investigation
bisphosphonate, cohort study, fracture risk, H2 receptor antagonists, osteoporosis, proton pump inhibitors
0937-941X
1989-1998
de Vries, F.
db4c0543-d6e7-476b-a10e-52d9d483f613
Cooper, A.L.
e216f10f-67ee-4ed6-9b69-e7ac7dec4eb3
Cockle, S.M.
cab8c9b5-5b00-4f15-b15a-2bb7cfb0692c
van Staa, T.-P.
438cdc38-714e-48f4-8eb5-41b0de820064
Cooper, C.
e05f5612-b493-4273-9b71-9e0ce32bdad6
de Vries, F.
db4c0543-d6e7-476b-a10e-52d9d483f613
Cooper, A.L.
e216f10f-67ee-4ed6-9b69-e7ac7dec4eb3
Cockle, S.M.
cab8c9b5-5b00-4f15-b15a-2bb7cfb0692c
van Staa, T.-P.
438cdc38-714e-48f4-8eb5-41b0de820064
Cooper, C.
e05f5612-b493-4273-9b71-9e0ce32bdad6

de Vries, F., Cooper, A.L., Cockle, S.M., van Staa, T.-P. and Cooper, C. (2009) Fracture risk in patients receiving acid-suppressant medication alone and in combination with bisphosphonates. Osteoporosis International, 20 (12), 1989-1998. (doi:10.1007/s00198-009-0891-4).

Record type: Article

Abstract

Summary: previous studies have found an association between acid suppressants and fracture risk. We assessed fracture risk in patients taking concomitant acid suppressant and bisphosphonates. Positive associations were observed for any hip and vertebral fracture. The effect size was modest; however, the significance lies in the widespread prescribing of acid suppressants.
Introduction: previous studies have found that acid-suppressive medication (ASM) is associated with an increased risk of fracture. Bisphosphonates can cause upper gastrointestinal problems, and patients may be prescribed ASM to minimise these effects.
Methods: a retrospective cohort study using the GPRD was conducted in patients aged 40 years and older starting proton pump inhibitors (PPI, N?=?234,144), H2 receptor antagonists (H2RA, N?=?166,798) or bisphosphonates (N?=?67,309). Fracture risk in current versus past use of ASM and concomitant use of bisphosphonate plus ASM versus bisphosphonate alone was compared using time-dependent Cox regression.
Results: in the 6 months before initiating bisphosphonate therapy, 20.1% of patients received a PPI and 7.5% an H2RA. Current PPI use was associated with an increased risk of any (adjusted relative rate (ARR) 1.15, 95% CI 1.10–1.20), hip (ARR 1.22, 95% CI 1.10–1.37), and vertebral fracture (ARR 1.40, 95% CI 1.11–1.78); and concomitant bisphosphonates and PPIs with an increased risk of any (ARR 1.08, 95% CI 1.01–1.16) and hip fracture (ARR 1.24, 95% CI 1.08–1.42).
Conclusions: ASM is associated with an increased risk of fracture when taken alone or in combination with bisphosphonates. Given the frequency of coprescription of ASM and bisphosphonates, this issue requires further investigation

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More information

Published date: December 2009
Keywords: bisphosphonate, cohort study, fracture risk, H2 receptor antagonists, osteoporosis, proton pump inhibitors

Identifiers

Local EPrints ID: 72901
URI: http://eprints.soton.ac.uk/id/eprint/72901
ISSN: 0937-941X
PURE UUID: bd8d6257-3e8d-4a7f-9bbb-829f4672feb9
ORCID for C. Cooper: ORCID iD orcid.org/0000-0003-3510-0709

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Date deposited: 24 Feb 2010
Last modified: 18 Mar 2024 02:44

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Contributors

Author: F. de Vries
Author: A.L. Cooper
Author: S.M. Cockle
Author: T.-P. van Staa
Author: C. Cooper ORCID iD

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