Review
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World J Methodol. Sep 26, 2011; 1(1): 15-21
Published online Sep 26, 2011. doi: 10.5662/wjm.v1.i1.15
Risk of fracture and pneumonia from acid suppressive drugs
Chun-Sick Eom, Sang-Soo Lee
Chun-Sick Eom, Department of Family Medicine, Institute for Skeletal Aging, Hallym University-Sacred Heart Hospital, Kangwondo 200-704, South Korea
Sang-Soo Lee, Institute for Skeletal Aging and Orthopedic Surgery, Infectious Disease Medical Research Center, Hallym University-Sacred Heart Hospital, Kangwondo 200-704, South Korea
Author contributions: Eom CS and Lee SS contributed equally to this paper.
Supported by Basic Science Research Program through the National Research Foundation of Korea funded by the Ministry of Education, Science and Technology (2011-000-6208 and 2011-001-4792)
Correspondence to: Sang-Soo Lee, MD, PhD, Professor, Director, Institute for Skeletal Aging and Orthopedic Surgery, Infectious Disease Medical Research Center, Hallym University-Sacred Heart Hospital, 153 Gyodong, Chunchonsi, Kangwondo 200-704, South Korea. totalhip@hallym.ac.kr
Telephone: +82-33-2405197 Fax: +82-33-2520177
Received: August 12, 2011
Revised: September 8, 2011
Accepted: September 19, 2011
Published online: September 26, 2011
Abstract

A recently published systematic review and meta-analysis, incorporating all relevant studies on the association of acid suppressive medications and pneumonia identified up to August 2009, revealed that for every 200 patients, treated with acid suppressive medication, one will develop pneumonia. They showed the overall risk of pneumonia was higher among people using proton pump inhibitors (PPIs) [adjusted odds ratio (OR) = 1.27, 95% CI: 1.11-1.46, I2 = 90.5%] and Histamine-2 receptor antagonists (H2RAs) (adjusted OR = 1.22, 95% CI: 1.09-1.36, I2 = 0.0%). In the randomized controlled trials, use of H2RAs was associated with an elevated risk of hospital-acquired pneumonia (relative risk 1.22, 95% CI: 1.01-1.48, I2 = 30.6%). Another meta-analysis of 11 studies published between 1997 and 2011 found that PPIs, which reduce stomach acid production, were associated with increased risk of fracture. The pooled OR for fracture was 1.29 (95% CI: 1.18-1.41) with use of PPIs and 1.10 (95% CI: 0.99-1.23) with use of H2RAs, when compared with non-use of the respective medications. Long-term use of PPIs increased the risk of any fracture (adjusted OR = 1.30, 95% CI: 1.15-1.48) and of hip fracture risk (adjusted OR = 1.34, 95% CI: 1.09-1.66), whereas long-term H2RA use was not significantly associated with fracture risk. Clinicians should carefully consider when deciding to prescribe acid-suppressive drugs, especially for patients who are already at risk for pneumonia and fracture. Since it is unnecessary to achieve an achlorhydric state in order to resolve symptoms, we recommend using the only minimum effective dose of drug required to achieve the desired therapeutic goals.

Keywords: Acid-suppressive drugs; Pneumonia; Fracture