PPIs and vertebral fracture risk

PPIs are widely used in clinical practice. There is evidence they may increase the risk of fracture and reduce the antifracture efficacy of bisphosphonates

Osteoporotic fracture: researchers examined the relationship between concomitant PPI use and incident vertebral fractures (Photograph: Sovereign, ISM/SPL)
Osteoporotic fracture: researchers examined the relationship between concomitant PPI use and incident vertebral fractures (Photograph: Sovereign, ISM/SPL)

Roux C, Goldstein JL, Zhou X et al. Osteoporos Int 2011; Mar 2
PPIs are widely used in clinical practice. There is evidence they may increase the risk of fracture and reduce the antifracture efficacy of bisphosphonates. One of the side-effects of bisphosphonates is GI irritation. The authors examined the relationship between concomitant use of PPIs and incident vertebral fractures among patients treated with risedronate or placebo.

The study was a post hoc analysis of a subset of patients participating in three prospective, placebo-controlled RCTs, with durations of up to three years, which evaluated the efficacy of risedronate in reducing fracture risk. It included 2,729 risedronate and 2,725 placebo patients with 8.8 per cent (n = 482) taking concomitant acid-suppressing drugs. The researchers found that regardless of PPI use, risedronate significantly reduced the risk of new vertebral fractures compared with placebo.

  • Professor Margaret Rees is reader emeritus in reproductive medicine, University of Oxford, John Radcliffe Hospital, Oxford

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