PPIs (proton pump inhibitors), medications taken for indigestion, can raise the risk of hip fractures by 35% in post-menopausal women, researchers from Massachusetts General Hospital reported in the BMJ (British Medical Journal). The authors added that women who smoke or used to smoke have a 50% higher risk of hip fractures when taking PPIs.

PPIs are commonly used for the treatment of heartburn, they are one of the most common medications used by both males and females globally. PPIs reduce gastric acid production. However, they can undermine the body’s ability to absorb calcium, which can eventually lead to weakened bones, making people more susceptible to fractures.

Examples of PPIs include:

  • Dexlansoprazole (Dexilant, Kapidex)
  • Esomeprazole (Nexium, Esotrex)
  • Lansoprazole (Inhibitol, Prevacid, Zoton, Lupizole, Monolitum, Levant)
  • Omeprazole (Omepral, Losec, Prilosec, Zegerid, Ocid, Lomac, Omez)
  • Pantoprazole (Zurcal, Zentro, Protonix, Somac, Controloc, Pantoloc, Pantozol, Pan)
  • Rabeprazole (Rabecid, AcipHex, Rabeloc, Zechin, Nzole-D, Pariet)

In this study, the researchers set out to determine what the link might be between PPI usage and hip fractures. They gathered data on nearly 80,000 females, all post-menopausal, from 2000 through 2008.

They found that post-menopausal females who take PPIs over prolonged periods and also smoke might be 50% more likely to have a hip fracture, compared to their non-smoking counterparts not on PPIs.

The authors explain that the several previous studies on this matter had conflicting or unconvincing findings because of limitations in the studies. The FDA (Food and Drug Administration) issued a warning of hip fracture risk linked to PPIs in 2010. However, the Agency added that further data was needed before a final analysis could be made.

Before coming to any conclusions in this study, the authors explained that they took several factors into account which might influence the final data, such as the women’s menopausal status, smoking status, levels of physical activity, calcium supplement usage, and BMI (body mass index). They also analyzed how much calcium the women were getting from the food they ate. They did not factor in events deemed as “low and moderate traumas”, such as falling on ice, falling from a chair, etc.

Out of the 79,899 women, all post-menopausal, there were 893 hip fractures. The researchers concluded that postmenopausal women on prolonged PPIs had a 35% higher risk of having a hip fracture, or 2.02 events per 1,000 person years, compared to 1.51 events among other women of the same age.

They also found that the longer a postmenopausal woman is taking PPIs, the greater is her risk of having a risk fracture.

8.9% of adult females were on PPIs in 2008, compared to 6.7% in 2000. This increased usage over time has prompted the FDA to revise the labeling of such medications. The authors say further studies are needed on regular female smokers on long-term PPI usage.

They added that hip fracture risk returned to normal 24 months after women stopped taking PPIs.

Written by Christian Nordqvist