4 5 6 PPIs may inhibit calcium absorption
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Primarily used for the treatment of heartburn symptoms, gastroesophageal reflux, or peptic ulcer, PPIs antagonise hydrogen potassium adenosine triphosphatase pumps located on gastric parietal cells,2 thereby reducing acid production to a greater extent than histamine receptor 2 (H2) blockers.3 Although short term use of PPIs is generally well tolerated, concern has grown over potential association between long term use and bone fractures, especially of the hip, which are known to be associated with substantial morbidity and mortality.4 5 6 PPIs may inhibit calcium absorption pandora bracelets https://www.pandoracharmsonsale.ca/,7 directly interfere with osteoclast function,8 or induce hypergastrinaemia, resulting in reductions in bone mineral density related to hyperparathyroidism.9Several studies have investigated the association between PPI use and risk of hip fracture.3 10 11 12 13 14 15 16 17 Many of these studies have had important limitations, including retrospective design,10 12 13 14 16 17 inability to control for important dietary and lifestyle confounders,3 10 12 13 14 16 small sample size,17 and limited ascertainment of PPI exposure.11 None the less, in May 2010 the Food and Drug Administration issued a warning regarding a potential association, but acknowledged that more data were needed.18We therefore sought to examine the association between long term PPI use and risk of hip fracture among postmenopausal women enrolled in a large prospective cohort, the Nurses’ Health Study, where detailed information about dietary and lifestyle factors are collected biennially.19 20 21 22 23 This cohort offered us an opportunity to examine PPI use in the context of other dietary and lifestyle risk factors that may either confound or modify its association with fracture. We also conducted a systematic review of our findings with prior studies to provide a more comprehensive estimate of the association.MethodsStudy populationThe Nurses’ Health Study is a prospective cohort that began in 1976 when 121700 US female registered nurses aged 30 55 years completed a mailed health questionnaire. We sent questionnaires to study participants every two years to update information and identify new cases of fracture; follow up has consistently exceeded 90%.
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