Medications can affect bone metabolism and be a secondary cause of osteoporosis. A recent publication has reviewed the data on a possible influence of proton pump inhibitors (PPIs) on the bone . PPIs, drugs in widespread use for gastroesophageal reflux and other gastric disorders, could impair intestinal calcium absorption, leading to a negative calcium balance, and resulting in bone loss and probable greater risk of fragility fractures . Increased hip fracture rates have been described related to long-term use of omeprazole, in two retrospective case-control studies published in 2006 [2, 3].
The first was conducted in the General Practice Research Database in the United Kingdom, studying patients older than 50 years, comparing users of PPIs versus non-users . The cases were all patients with a first-occurrence incident of hip fracture (n = 13,556); ten controls were selected for each case from the study cohort (n = 135,386). After more than 1 year of PPI therapy, the adjusted odds ratio for hip fracture was 1.44 (95% confidence interval (CI) 1.30–1.59). This association was significantly higher with high-dose treatments, and the strength of the association increased significantly with longer duration of therapy (duration category of 4 years).
The other case–control study was conducted in a Danish population  and also showed an association of PPI therapy (used within the last year) with an increased risk of hip fractures (OR 1.45; 95% CI 1.28–1.65), although this was neither a dose-response nor a duration-response effect (duration category defined as more than 3 months).
Department of Endocrinology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
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