Increased Risk of Fractures and Use of Proton Pump Inhibitors in Menopausal Women: A Systematic Review and Meta-Analysis

Overview

Journal Int J Environ Res Public Health

Publisher MDPI

Specialties Environmental Health
Public Health

Date 2022 Oct 27

PMID 36294082

Authors

Thuila Ferreira da Maia

Bruna Gafo de Camargo

Meire Ellen Pereira

Claudia Sirlene de Oliveira

Izonete Cristina Guiloski

Affiliations

Soon will be listed here.

Abstract

Proton pump inhibitors (PPIs) can directly interfere with osteoclastic function, induce hypergastrinemia, and inhibit calcium absorption, leading to reduced bone mineral density (BMD), a measure of bone metabolism that may be associated with the risk of fractures. The current study involves a systematic review and meta-analysis aimed at assessing the relationship between prolonged use of PPI drugs and fractures in menopausal women. A systematic search and meta-analysis were performed on PubMed, Scopus, and Science Direct databases according to PRISMA guidelines. Two independent reviewers analyzed the articles. The five articles found in the databases, which met the eligibility criteria, covered participants who were menopausal women aged between 56 and 78.5 years, using or not using a PPI for a minimum of 12 months. All studies showed an increase in the rate of fractures related to using PPIs, as an outcome. Prolonged use of PPIs in menopausal women can affect bone metabolism and cause fractures. However, other factors, such as the use of other classes of drugs, obesity, low weight, poor diet, replacement hormones, and comorbidities, should also be considered for assessing the risk of fractures.

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References

Liberati A, Altman D, Tetzlaff J, Mulrow C, Gotzsche P, Ioannidis J . The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ. 2009; 339:b2700. PMC: 2714672. DOI: 10.1136/bmj.b2700. View

Karlamangla A, Burnett-Bowie S, Crandall C . Bone Health During the Menopause Transition and Beyond. Obstet Gynecol Clin North Am. 2018; 45(4):695-708. PMC: 6226267. DOI: 10.1016/j.ogc.2018.07.012. View

Stang A . Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol. 2010; 25(9):603-5. DOI: 10.1007/s10654-010-9491-z. View

Khalili H, Huang E, Jacobson B, Camargo Jr C, Feskanich D, Chan A . Use of proton pump inhibitors and risk of hip fracture in relation to dietary and lifestyle factors: a prospective cohort study. BMJ. 2012; 344:e372. PMC: 3269660. DOI: 10.1136/bmj.e372. View

Faubion S, Kuhle C, Shuster L, Rocca W . Long-term health consequences of premature or early menopause and considerations for management. Climacteric. 2015; 18(4):483-91. PMC: 4581591. DOI: 10.3109/13697137.2015.1020484. View

Anam A, Insogna K . Update on Osteoporosis Screening and Management. Med Clin North Am. 2021; 105(6):1117-1134. DOI: 10.1016/j.mcna.2021.05.016. View

Gray S, LaCroix A, Larson J, Robbins J, Cauley J, Manson J . Proton pump inhibitor use, hip fracture, and change in bone mineral density in postmenopausal women: results from the Women's Health Initiative. Arch Intern Med. 2010; 170(9):765-71. PMC: 4240017. DOI: 10.1001/archinternmed.2010.94. View

Poly T, Islam M, Yang H, Wu C, Li Y . Proton pump inhibitors and risk of hip fracture: a meta-analysis of observational studies. Osteoporos Int. 2018; 30(1):103-114. DOI: 10.1007/s00198-018-4788-y. View

Fournier M, Targownik L, Leslie W . Proton pump inhibitors, osteoporosis, and osteoporosis-related fractures. Maturitas. 2009; 64(1):9-13. DOI: 10.1016/j.maturitas.2009.07.006. View

10.

Yang Y, Lewis J, Epstein S, Metz D . Long-term proton pump inhibitor therapy and risk of hip fracture. JAMA. 2006; 296(24):2947-53. DOI: 10.1001/jama.296.24.2947. View

11.

van der Hoorn M, Tett S, de Vries O, Dobson A, Peeters G . The effect of dose and type of proton pump inhibitor use on risk of fractures and osteoporosis treatment in older Australian women: A prospective cohort study. Bone. 2015; 81:675-682. DOI: 10.1016/j.bone.2015.08.024. View

12.

Roux C, Briot K, Gossec L, Kolta S, Blenk T, Felsenberg D . Increase in vertebral fracture risk in postmenopausal women using omeprazole. Calcif Tissue Int. 2008; 84(1):13-9. DOI: 10.1007/s00223-008-9188-4. View

13.

Lewis J, Barre D, Zhu K, Ivey K, Lim E, Hughes J . Long-term proton pump inhibitor therapy and falls and fractures in elderly women: a prospective cohort study. J Bone Miner Res. 2014; 29(11):2489-97. DOI: 10.1002/jbmr.2279. View

14.

OConnell M, Madden D, Murray A, Heaney R, Kerzner L . Effects of proton pump inhibitors on calcium carbonate absorption in women: a randomized crossover trial. Am J Med. 2005; 118(7):778-81. DOI: 10.1016/j.amjmed.2005.02.007. View

15.

Moberg L, Nilsson P, Samsioe G, Borgfeldt C . Use of proton pump inhibitors (PPI) and history of earlier fracture are independent risk factors for fracture in postmenopausal women. The WHILA study. Maturitas. 2014; 78(4):310-5. DOI: 10.1016/j.maturitas.2014.05.019. View

16.

Ngamruengphong S, Leontiadis G, Radhi S, Dentino A, Nugent K . Proton pump inhibitors and risk of fracture: a systematic review and meta-analysis of observational studies. Am J Gastroenterol. 2011; 106(7):1209-18. DOI: 10.1038/ajg.2011.113. View

17.

Gosset A, Pouilles J, Tremollieres F . Menopausal hormone therapy for the management of osteoporosis. Best Pract Res Clin Endocrinol Metab. 2021; 35(6):101551. DOI: 10.1016/j.beem.2021.101551. View

18.

Brozek W, Reichardt B, Zwerina J, Dimai H, Klaushofer K, Zwettler E . Higher dose but not low dose proton pump inhibitors are associated with increased risk of subsequent hip fractures after first hip fracture: A nationwide observational cohort study. Bone Rep. 2019; 10:100204. PMC: 6451165. DOI: 10.1016/j.bonr.2019.100204. View

19.

Naunton M, Peterson G, Bleasel M . Overuse of proton pump inhibitors. J Clin Pharm Ther. 2000; 25(5):333-40. DOI: 10.1046/j.1365-2710.2000.00312.x. View

20.

Davoudi-Kiakalayeh A, Mohammadi R, Pourfathollah A, Siery Z, Davoudi-Kiakalayeh S . Alloimmunization in Thalassemia Patients: New Insight for Healthcare. Int J Prev Med. 2018; 8:101. PMC: 5738786. DOI: 10.4103/ijpvm.IJPVM_246_16. View