Introduction
Proton pump inhibitors (PPIs) are widely used for the treatment of peptic ulcer and gastro-esophageal reflux diseases, and as mucosal gastric protectors in patients receiving anti-aggregation drugs for cardiovascular diseases.
Although PPIs are well tolerated, concerns have been raised that their chronic use may pose risks of dementia, gastric cancer,and pneumonia.Recently, researchers have suggested that chronic use of PPIs such as omeprazole may also be a risk factor for osteoporotic bone fractures,1,2 but the findings are controversial.3,4
Aims & Methods
Aim: The aim of the study was to investigate the potential association of chronic use of omeprazole with the occurrence of osteoporotic fractures (OF) in community-dwelling elderly subjects.
Methods: The cohort consisted of community-dwelling residents aged >65 years registered with a large health maintenance organization in Israel between 01/2002 and 12/2016. Data were retrospectively collected from the electronic medical files on demographics, parameters known to be associated with OF, diagnoses of osteoporotic hip, wrist, and vertebral fractures, and chronic use of omeprazole ( >11 prescriptions/year). Time to OF/death/end of study was calculated from the beginning of the study (2002). The risk of fractures in omeprazole the chronic users was analyzed by multivariate Cox proportional hazard regression model.
Results
Included 46,805 subjects (41% men), mean age 83.4±6.4 years, of whom 10,272 (21.9%) were chronic users of omeprazole.
During 14 years of follow-up, OF were diagnosed in 414 (4.0%) omeprazole users and 1007 (2.8%) omeprazole nonusers (p<0.001). In a Cox regression model adjusted for age and gender only, chronic use of omeprazole was associated with a 16% excess of osteoporotic fractures. However, when parameters known to be associated with osteoporotic fractures were entered into the multivariate Cox regression model, chronic use of omeprazole was not found to be an independent risk factor for osteoporotic fracture, either overall (aHR=0.965, 95% CI 0.86–1.08, p=0.55) or specifically, in the ≥85-year age group (aHR=0.780, 95% CI 0.635–0.958, p<0.05) in which an inverse correlation between omeprazole use and osteoporotic fracture, was demonstrated.
Conclusion
Chronic use of omeprazole wasn’t associated with the occurrence of osteoporotic fractures in community-dwelling elders.
References
References:
1 . Yang YX, Lewis JD, Epstein S, Metz DC. Long-term proton pump inhibitor therapy and risk of hip fracture. JAMA 2006; 296: 2947‒2953.
2. Targownik LE, Lix LM, Metge CJ, Prior HJ, Leung S, Leslie WD. Use of proton pump inhibitors and risk of osteoporosis-related fractures. CMAJ 2008; 179: 319‒326.
3 . Targownik LE, Lix LM, Leung S, Leslie WD. Proton-pump inhibitor use is not associated with osteoporosis or accelerated bone mineral density loss. Gastroenterology 2010; 138: 896-904.
4. Moayyedi P, Eikelboom JW, Bosch J et al; COMPASS Investigators. Safety of proton pump inhibitors based on a large, multi-year, randomized trial of patients receiving rivaroxaban or aspirin. Gastroenterology 2019; 157: 682‒691.e2.
Disclosure
Nothing to declare