Acid-Suppressive Medications and Risk of Bone Loss and Fracture in Older Adults Running Title: Acid-Suppressive Drugs: Bone Loss Fracture Risk

摘要

Recent studies have suggested an increased fracture risk with acid-suppressive medication use. We studied two cohorts of men and women over age 65 who were enrolled in the Osteoporotic Fractures in Men Study (MrOS) and the Study of Osteoporotic Fractures (SOF), respectively. We measured DXA and assessed baseline use of PPIs and/or H2RAs in 5755 men and 5339 women. Reassessment of medication use and repeat BMD were performed, and assessment of hip and other non-spine fractures were documented. On multivariate analysis, men using either PPIs or H2RAs had lower cross-sectional bone mass. No significant BMD differences were observed among women. However, there was an increased risk of non-spine fracture among women using PPIs (RH=1.34; 95% CI 1.10-1.64). PPI use was also associated with an increased risk of non-spine fracture in men, but only among those who were not taking calcium supplements (RH=1.49; 95% CI 1.04-2.14). H2RA use was not associated with non-spine fractures, and neither H2RA nor PPI use was associated with incident hip fractures in men or women. The use of PPIs in older women, and perhaps older men with low calcium intake, may be associated with a modest increased risk of non-spine fracture.