Common PPI drugs linked to higher risk of bone fractures

ONE OF the most commonly prescribed medications in the State has been linked to a small increased risk of bone fractures in those using it for prolonged periods, the Irish Medicines Board (IMB) has said.

In the latest edition of its Drug Safety newsletter, the IMB warns doctors and pharmacists that a class of acid-suppressing drugs called proton pump inhibitors (PPIs) may slightly increase the risk of hip, wrist and spine fractures in certain groups of patients.

PPIs treat stomach and duodenal ulcers as well as the reflux of acid from stomach to gullet. In combination with antibiotics they are used to eradicate the stomach bacterium Helicobacter pylori.

Those most at-risk include older people and patients with risk factors for osteoporosis (bone thinning). PPIs used at high dosage and for periods greater than a year were implicated in a review of their safety. The European Medicines Agency review of 10 studies found inconsistencies between them in terms of the magnitude of the risk and the length of treatment that led to the side-effect. But it concluded there was a modest increase in the overall risk of fracture, with the risk of hip and spine fracture being the greatest.

“The majority, but not all, of the studies showed a small increased risk of fractures, however, in view of the extensive usage of PPIs, it was considered that information on the risk should be included in the product information where authorised for longer term use,” the IMB says.

While the exact cause is unknown, it is thought PPIs could affect calcium and magnesium balance in the body or on vitamin D and parathyroid hormone levels.

The drugs in the review were esomprazole, lansoprazole, omeprazole, pantoprazole and rabeprazole. Their trade names include Losec, Nexium, Protium, Pariet and Zoton. In 2009, PPIs accounted for more than 6 per cent of all drugs prescribed under the medical card scheme.