Verschiedene Studien legen eine erhöhte Rate an Knochenfrakturen bei Patientinnen und Patienten mit langfristiger PPI-Einnahme nahe. PPI greifen tief in den Stoffwechsel und den Knochenstoffwechsel ein. Das Auftreten dieser Knochenbrüche soll unabhängig von einer Osteoporose sein. Frakturen bei Patientinnen und Patienten, die PPI einnehmen wurden an verschiedenen Knochen beschrieben: Hüfte, Handgelenke, Wirbelkörper.
Literatur
Publikationen die erhöhte Frakturrate unter PPI-Einnahme zeigen
Results of this meta-analysis suggest that PPI may moderately increase the risk of any-site, hip, spine fracture. Due to the widespread use of PPI and the impact of fractures on human health, clinicians should carefully evaluate the patient condition before prescribing PPI therapy.
Liu et al., 2019, Life Sci 218: 213-223
This meta-analysis suggests that PPI user have a 26% increased risk of hip fracture as compared to non-PPI user. Physicians should take caution in prescribing PPI to patients who are at increased risk of hip fracture.
Hussain et al., 2018, Rheumatol Int 38: 1999-2014
Yang HC, Wu CC, Li YJ. Proton pump inhibitors and risk of hip fracture: a meta-analysis of observational studies. Osteoporos Int. 2019 Jan;30(1):103-114. doi: 10.1007/s00198-018-4788-y. Epub 2018
In this large prospective population-based cohort study, we found an association between PPI use and increased risk of fragility fracture. Although the increased risk found was modest, this finding is important, given the high prevalence of PPI use and the excess morbidity and mortality associated with osteoporosis-related fractures.
Fraser et al., 2013, Osteoporos Int. 24: 1161-1168
Long-term PPI therapy, particularly at high doses, is associated with an increased risk of hip fracture.
Yang et al., 2006 JAMA. 296: 2947-2953
Cea Soriano L, Ruigómez A, Johansson S, García Rodríguez LA. Study of the association between hip fracture and acid-suppressive drug use in a UK primary care setting. Pharmacotherapy. 2014 Jun;34(6):570-81. doi: 10.1002/phar.1410. Epub 2014 Mar 13.
Patients treated with PPIs showed a modest increased risk of hip fracture after adjustment for potential cofounders. Any remaining association between PPI use and hip fracture risk may be attributable to residual confounding.
Cea Soriano et al., 2014, Pharmacotherapy 34:570-581
Wilson C. Bone: proton-pump inhibitors and fractures. Nat Rev Endocrinol. 2012 Nov;8(11):625.
Use of PPIs was not associated with hip fractures but was modestly associated with clinical spine, forearm or wrist, and total fractures.
Gray et al., 2010, Arch Intern Med170:765-71
Publikationen, die das erhöhte Frakturrisko unter PPI Einnahme in Frage stellen
“Long-term PPI use is not associated with any changes in bone mineral density or bone strength that would predispose to an increased risk of fracture. These findings provide further evidence that the association between PPI use and fracture is not causal.”
Targownik et al. 2017, Am J Gastroenterol. 112: 95-101.
“Overall, though multiple observational studies have demonstrated an association between PPIs and fragility fractures, the lack of a proven mechanism through which PPIs increase the risk of fracture suggests that this association may not be causal. At this time, the authors do not recommend discontinuing PPIs in patients with a history of fracture or those at increased risk of fracture. However, clinicians should still endeavor to avoid using PPIs in situations where benefits are minimal or clinical indications are lacking.”
Targownik & Leslie, 2011, Expert Opin Drug Saf. 10: 901-912.