title: Use of proton pump inhibitors is associated with fractures in young adults: a population-based study.
abstract: Proton pump inhibitors (PPIs) are associated with risk for fracture in osteoporotic adults. In this population-based study, we found a significant association between PPIs and fracture in young adults, with evidence of a dose-response effect. Young adults who use PPIs should be cautioned regarding risk for fracture.
  
  
  BACKGROUND
  Proton pump inhibitors (PPIs) are associated with fracture in adults with osteoporosis. Because PPI therapy may interfere with bone accrual and attainment of peak bone mineral density, we studied the association between use of PPIs and fracture in children and young adults.
  
  
  METHODS
  We conducted a population-based, case-control study nested within records from general medical practices from 1994 to 2013. Participants were 4-29 years old with ≥ 1 year of follow-up who lacked chronic conditions associated with use of long-term acid suppression. Cases of fracture were defined as the first incident fracture at any site. Using incidence density sampling, cases were matched with up to five controls by age, sex, medical practice, and start of follow-up. PPI exposure was defined as 180 or more cumulative doses of PPIs. Conditional logistic regression was used to estimate the odds ratio and confidence interval for use of PPIs and fracture.
  
  
  RESULTS
  We identified 124,799 cases and 605,643 controls. The adjusted odds ratio for the risk of fracture associated with PPI exposure was 1.13 (95% CI 0.92 to 1.39) among children aged < 18 years old and 1.39 (95% CI 1.26 to 1.53) among young adults aged 18-29 years old. In young adults but not children, we observed a dose-response effect with increased total exposure to PPIs (p for trend <0.001).
  
  
  CONCLUSIONS
  PPI use was associated with fracture in young adults, but overall evidence did not support a PPI-fracture relationship in children. Young adults who use PPIs should be cautioned regarding potentially increased risk for fracture, even if they lack traditional fracture risk factors.
authors.affiliation: Division of Digestive and Liver Diseases, Columbia University Medical Center, 630 West 168th Street, PH-7, New York, NY, 10032, USA. def2004@cumc.columbia.edu.
authors.forename: D E
authors.initials: DE
authors.lastname: Freedberg
authors.affiliation: Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA.
authors.forename: K
authors.initials: K
authors.lastname: Haynes
authors.affiliation: Division of Nephrology, The Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA.
authors.forename: M R
authors.initials: MR
authors.lastname: Denburg
authors.affiliation: Department of Pediatrics, The Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA.
authors.forename: B S
authors.initials: BS
authors.lastname: Zemel
authors.affiliation: Departments of Medicine and Pediatrics, Stanford University School of Medicine, Stanford, CA, 94305, USA.
authors.forename: M B
authors.initials: MB
authors.lastname: Leonard
authors.affiliation: Division of Digestive and Liver Diseases, Columbia University Medical Center, 630 West 168th Street, PH-7, New York, NY, 10032, USA.
authors.forename: J A
authors.initials: JA
authors.lastname: Abrams
authors.affiliation: Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA.|Division of Gastroenterology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA.
authors.forename: Y-X
authors.initials: YX
authors.lastname: Yang
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D006635:Histamine H2 Antagonists / Q000009:adverse effects; D006801:Humans; D008297:Male; D058866:Osteoporotic Fractures / Q000139:chemically induced* / Q000453:epidemiology; D054328:Proton Pump Inhibitors / Q000008:administration & dosage / Q000009:adverse effects*; D006113:United Kingdom / Q000453:epidemiology; D055815:Young Adult
chemical_list: D006635:Histamine H2 Antagonists; D054328:Proton Pump Inhibitors
keywords: Acid suppression medications; Bone mineral density; Fracture; Histamine-2 receptor antagonists; Osteoporosis; Outcomes research; Pediatrics; Pharmacoepidemiology; Proton pump inhibitors