Hip fracture and proton pump inhibitor therapy: balancing the evidence for benefit and harm.
Gastroenterology is full of examples of drugs being enthusiastically promoted only to be withdrawn or prescription curtailed once the harms of the medication are realized. Cox-2 inhibitors, alosetron, and tegaserod are all recent examples of this phenomenon. The problem is that potential harms of drugs are being highlighted in the medical literature all the time and it can be difficult to determine whether these represent a genuine risk to our patients or are just spurious epidemiological associations. The association between proton pump inhibitor therapy and hip fracture is a good illustration of this dilemma. We use this example to highlight an approach that can be taken to critically evaluate the evidence for harms of medication.
Division of Gastroenterology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
Paul
P
Moayyedi
Ann
A
Cranney
D000367:Age Factors; D002118:Calcium / Q000378:metabolism*; D004305:Dose-Response Relationship, Drug; D005764:Gastroesophageal Reflux / Q000188:drug therapy*; D014943:Global Health; D006620:Hip Fractures / Q000139:chemically induced* / Q000453:epidemiology / Q000378:metabolism; D006801:Humans; D015994:Incidence; D007408:Intestinal Absorption / Q000187:drug effects*; D011379:Prognosis; D054328:Proton Pump Inhibitors / Q000008:administration & dosage / Q000009:adverse effects*; D012307:Risk Factors
D054328:Proton Pump Inhibitors; D002118:Calcium