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Jury Still Out on PPI Hip Fractures, Other Fractures Likely

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Seattle, WANew research into proton pump inhibitor (PPI) side effects as they relate to hip fractures suggest that the greater concern may actually be fractures to other areas of the body. According to a report in the August Ob.Gyn. News, the use of a proton pump inhibitor may modestly raise the risk of fracture to the spine, forearm and wrist.

Given the fact that some large epidemiological studies have suggested an increase in PPI osteoporotic fractures, while others have not, a team of researchers led by Shelly L. Gray at the University of Washington School of Pharmacy in Seattle examined data from the Women's Health Initiative in an attempt to delve deeper into the subject.

Analyzing data from 161,806 women in the 50-79 age demographic, researchers found that women who took PPIs were more likely than others to have osteoporosis or a history of fractures, obesity, treated diabetes or a history of several health conditions. They were also less likely to take other medications chronically and had better self-reported health and physical function.

According to the researchers, once the data were adjusted to account for potential confounding factors, PPI side effects were not found to be related to hip fracture risk—nor was there found to be any relationship with the duration of PPI use.

However, it was found that the use of proton pump inhibitors and the two drugs in question raised the relative risk of clinical spine fracture by 47 percent, the relative risk of forearm or wrist fracture by 26 percent, and the relative risk of total fractures by 25 percent.

Two percent of the study subjects were taking omeprazole or lansoprazole at baseline. . "We did our best to adjust for these baseline differences, but, like all observational studies, residual or unmeasured confounding could explain increased associations for some fracture types," Dr. Gray said.

Dr. Mitchell H. Katz of the San Francisco Department of Health noted that the increase in non-hip fractures was 'modest,' but that the use of proton pump inhibitors was so widespread that such modest increases "add up to a lot of morbidity on a population level."

The Women's Health Initiative is a large study of an ethnically diverse cohort of postmenopausal women followed at 40 US medical centers, for a mean of 7.8 years.

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