According to an investigation published on bmj.com, hip fractures are 35% more likely to occur in post-menopausal women if they take indigestion medications, known as proton pump inhibitors (PPIs). This figure rises to 50% if the women are former or current smokers.

Globally, PPIs are one of the most prevalent drugs used, and are often used to treat acid reflex and heartburn. However, PPIs can prevent calcium absorption, which leads to the increased risk of fractures.

From 2000 to 2008, researchers from the Massachusetts General Hospital examined the link between hip fractures and PPIs in just under 80,000 post-menopausal women.

According to the researchers, women who smoke and take PPIs for an extended period of time may be up to two times more likely to suffer from hip fractures than women who do not take PPIs or smoke.

In response to the increasing worries regarding long-term PPI use and the risk of hip fractures, numerous investigations have been conducted, although they have been met with considerable limitations.

The Food and Drug Administration (FDA) issued a warning in May 2010 of PPI use and hip fractures, however they concluded that more data was required for a full examination.

The researchers took into account several factors, such as:

  • alcohol intake
  • body weight
  • duration of physical activity
  • smoking status
  • calcium supplement usage
  • menopausal status

In addition, the team examined calcium intake from food included in each participant’s diet. High traumas, such as falling down the stairs or skiing accidents were not included, while low and moderate traumas associated to fracture, such as falling off a chair, or falling on ice were recorded.

From 2000 to 2008, results showed that there was a total of 893 hip fractures out of the 79,889 post-menopausal women, concluding that post-menopausal women had a 35% increased risk of hip fracture.

The researchers found that the risk of hip fracture among individuals who regularly use PPIs was 2.02 events per 1,000 person years (the number of years of follow up multiplied by the number of participants in the study), in comparison with 1.51 events per 1,000 person years among women who did not use PPIs. Current and former smokers were at an even higher risk of 50%. The researchers also found association between the risk of fractures and the duration of time PPIs were taken.

In 2000, 6.7% of women regularly used a PPI, this figure rose to 18.9% in 2008, which poses a greater risk of fractures linked to PPIs in the coming years. Due to this, the FDA plans to revise labeling on these medications and the researchers underline the importance of assessing the need for long-term use of PPIs among individuals with a history of smoking. The researchers highlight that two years after patients stopped taking PPIs, their risk of hip fracture returned to normal.

Written by Grace Rattue