Yang YX, Lewis JD, Epstein S, Metz DC. Long-term proton pump inhibitor therapy and risk of hip fracture. JAMA. 2006 Dec 27;296(24):2947-53. (Full Text)
Posted by Dr. Sergio Brantes
El riesgo de fractura de cadera aumenta con el uso de inhibidores de la bomba de protones, tales como omeprazol.
El riesgo relativo es de 1,44 el usuarias de un año y sube hasta 2,65 en las que usan dosis altas o por mas de cinco años.
Los autores diseñaron el estudio con la hipótesis que la hipoclorhídria iatrogénica podría afectar la absorción de calcio y por ese mecanismo afectar al hueso.
Encontraron correlación entre riesgo de fractura de cadera y uso de inhibidores de protones, porporcional al tiempo de uso y dosis de omeprazol o fármacos afines.
El estudio involucra a más de 13.000 casos y otros tantos controles, de edad promedio 77(± 9,3) años.
El riesgo relativo de las mujeres bajo tratamiento hormonal fue de OR: 0,53 (95% IC 0,39-0,71)
ABSTRACT
Long-term Proton Pump Inhibitor Therapy and Risk of Hip Fracture
Yu-Xiao Yang, MD, MSCE; James D. Lewis, MD, MSCE; Solomon Epstein, MD; David C. Metz, MD
JAMA. 2006;296:2947-2953.
Context Proton pump inhibitors (PPIs) may interfere with calcium absorption through induction of hypochlorhydria but they also may reduce bone resorption through inhibition of osteoclastic vacuolar proton pumps.
Objective To determine the association between PPI therapy and risk of hip fracture.
Design, Setting, and Patients A nested case-control study was conducted using the General Practice Research Database (1987-2003), which contains information on patients in the United Kingdom. The study cohort consisted of users of PPI therapy and nonusers of acid suppression drugs who were older than 50 years. Cases included all patients with an incident hip fracture. Controls were selected using incidence density sampling, matched for sex, index date, year of birth, and both calendar period and duration of up-to-standard follow-up before the index date. For comparison purposes, a similar nested case-control analysis for histamine 2 receptor antagonists was performed.
Main Outcome Measure The risk of hip fractures associated with PPI use.
Results There were 13 556 hip fracture cases and 135 386 controls. The adjusted odds ratio (AOR) for hip fracture associated with more than 1 year of PPI therapy was 1.44 (95% confidence interval [CI], 1.30-1.59). The risk of hip fracture was significantly increased among patients prescribed long-term high-dose PPIs (AOR, 2.65; 95% CI, 1.80-3.90; P<.001). The strength of the association increased with increasing duration of PPI therapy (AOR for 1 year, 1.22 [95% CI, 1.15-1.30]; 2 years, 1.41 [95% CI, 1.28-1.56]; 3 years, 1.54 [95% CI, 1.37-1.73]; and 4 years, 1.59 [95% CI, 1.39-1.80]; P<.001 for all comparisons).
Conclusion Long-term PPI therapy, particularly at high doses, is associated with an increased risk of hip fracture.