Common indigestion drugs taken by millions of people may increase the risk of a hip fracture by a third, a study has found.
Hopping for two minutes can improve bone density Photo: ALAMY
Post-menopausal women who take drugs known as
proton pump inhibitors are around 35 per cent per cent more likely to
suffer a broken hip, research has suggested.
Millions of people take the drugs for heartburn, acid reflux, or peptic ulcers.
The longer the women took the drugs, the higher the risk of a fracture,
as the research shows those taking them for six to eight years were 50
per cent more likely to suffer a broken hip.
The most commonly used were omeprazole, which can be bought over the counter, and lansoprazole.
The study provides 'compelling evidence' of a 'significant association'
between proton pump inhibitors and hip fractures, the researchers said.
Careful consideration should be given to prescribing the drugs for long-term use, they said.
The drugs are thought to interfere with the body's absorption of calcium which is vital for strong bones.
American drugs regulators issued a warning about long-term use of proton pump inhibitors and hip fractures last year but said more data was needed to establish the risk.
Now researchers, studying 80,000 American nurses, found that for every 2,000 post-menopausal women taking the drugs for a year, there would be more than four fractures compared with three in 2,000 women not taking them.
The study, published in the British Medical Journal, showed the risk of hip fracture among women who regularly used PPIs for at least two years was 35 per cent higher.
A longer use of PPIs was linked with an increasing risk.
The finding held true even when factors likely to influence the result, such as how much exercise women did or their calcium intake, were taken into account.
The risk of hip fracture did, however, return to a normal level two years after patients stopped taking PPIs.
Lead author Hamed Khalili clinical and research fellow, from Massachusetts General Hospital, in America wrote: "Our results, considered in the context of a systematic review of prior studies, provide compelling evidence of a significant association between PPI use and fracture.
"Furthermore, in view of the steadily growing prevalence of regular PPI use, our estimates of an absolute increase in risk of five hip fractures per 10 000 person years associated with PPI use suggest the potential for a high burden of fractures attributable to PPIs across the population.
"These findings further support the recent decision of the Food and Drug Administration to revise labelling of PPIs to incorporate concerns about a possible increase in risk of fractures with these drugs.
"Our data suggest the importance of carefully evaluating the need for long term, continuous use of PPIs, particularly among individuals with a history of smoking."
Indigestion is a common problem and NHS estimates are that up to 41 per cent of the population will experience it at some point.
Last year there were almost 40m prescriptions dispensed in England for proton pump inhibitors.
Although mild side-effects are already known – including headache, nausea, abdominal pain and skin rashes – the new study found "compelling evidence" that women could be put at risk of fractures after the menopause.
Tobie de Villiers, President of the International Menopause Society, said: “Although the relative risk of hip fracture is significantly raised in users of PPI, when compared to non-users, the absolute risk increase is small.
"This is still important in view of the widespread use of PPIs and the significant burden of disease of hip fractures on affected individuals and the health care system.
"It is worrying that even the use of common anti-fracture drugs do not affect this association.
"The conclusion of this study will need to be considered in clinical practice as it is biologically plausible and supported by other studies.”
Dr John C Stevenson, Consultant Physician and Reader, at the Royal Brompton Hospital, said: "It has been suspected for a number of years that a certain type of indigestion pills, proton pump inhibitors, increase the risk of hip fracture.
"This large study confirms that suspicion. However, the absolute risk is small, with the drugs causing an additional five hip fractures per 10,000 women per year.
"Women should not be put off using proton pump inhibitors if they are needed, but these results provide yet another reason not to smoke."
The drugs are thought to interfere with the body's absorption of calcium which is vital for strong bones.
American drugs regulators issued a warning about long-term use of proton pump inhibitors and hip fractures last year but said more data was needed to establish the risk.
Now researchers, studying 80,000 American nurses, found that for every 2,000 post-menopausal women taking the drugs for a year, there would be more than four fractures compared with three in 2,000 women not taking them.
The study, published in the British Medical Journal, showed the risk of hip fracture among women who regularly used PPIs for at least two years was 35 per cent higher.
A longer use of PPIs was linked with an increasing risk.
The finding held true even when factors likely to influence the result, such as how much exercise women did or their calcium intake, were taken into account.
The risk of hip fracture did, however, return to a normal level two years after patients stopped taking PPIs.
Lead author Hamed Khalili clinical and research fellow, from Massachusetts General Hospital, in America wrote: "Our results, considered in the context of a systematic review of prior studies, provide compelling evidence of a significant association between PPI use and fracture.
"Furthermore, in view of the steadily growing prevalence of regular PPI use, our estimates of an absolute increase in risk of five hip fractures per 10 000 person years associated with PPI use suggest the potential for a high burden of fractures attributable to PPIs across the population.
"These findings further support the recent decision of the Food and Drug Administration to revise labelling of PPIs to incorporate concerns about a possible increase in risk of fractures with these drugs.
"Our data suggest the importance of carefully evaluating the need for long term, continuous use of PPIs, particularly among individuals with a history of smoking."
Indigestion is a common problem and NHS estimates are that up to 41 per cent of the population will experience it at some point.
Last year there were almost 40m prescriptions dispensed in England for proton pump inhibitors.
Although mild side-effects are already known – including headache, nausea, abdominal pain and skin rashes – the new study found "compelling evidence" that women could be put at risk of fractures after the menopause.
Tobie de Villiers, President of the International Menopause Society, said: “Although the relative risk of hip fracture is significantly raised in users of PPI, when compared to non-users, the absolute risk increase is small.
"This is still important in view of the widespread use of PPIs and the significant burden of disease of hip fractures on affected individuals and the health care system.
"It is worrying that even the use of common anti-fracture drugs do not affect this association.
"The conclusion of this study will need to be considered in clinical practice as it is biologically plausible and supported by other studies.”
Dr John C Stevenson, Consultant Physician and Reader, at the Royal Brompton Hospital, said: "It has been suspected for a number of years that a certain type of indigestion pills, proton pump inhibitors, increase the risk of hip fracture.
"This large study confirms that suspicion. However, the absolute risk is small, with the drugs causing an additional five hip fractures per 10,000 women per year.
"Women should not be put off using proton pump inhibitors if they are needed, but these results provide yet another reason not to smoke."
