title: Acid-suppressive medications and risk of fracture: an updated meta-analysis.
abstract: BACKGROUND
  Acid-suppressive medications are widely used for the management of acid-related disorders. It has been reported that acid-suppressive medication users were at increased risk of fracture, but such an association was inconsistent among observational studies. The purpose of our analysis was to assess the relationship between use of antacid drugs and fracture risk.
  
  
  METHODS
  We systematically searched electronic database and manually examined the reference lists of previous reviews for potentially eligible studies. Given the heterogeneity across studies, random effects models were used to calculate summary estimates. Subgroup analysis and sensitivity analysis were conducted to explore the potential heterogeneity.
  
  
  RESULTS
  18 studies met our inclusion criteria. PPI and H2RA were associated with increased risk of hip fracture, with substantial heterogeneity (PPI: 1.216, 1.134-1.304, I(2)=71.3%; H2RA: 1.128, 1.022-1.245, I(2)=72.1%). High risk of spine fracture was observed in PPI users (1.216, 95% CI: 1.134-1.304) but not H2RA users. When considering 5 studies conducted among postmenopausal women, the RR was 1.376, (95% CI: 1.043-1.816) with modest heterogeneity (I(2)=57.7%). Subgroup analysis and sensitivity analysis found consistent association between hip fracture risk and PPI use but not H2RA use. Positive association for H2RA use lost its significance when considering case-control studies and European studies.
  
  
  CONCLUSIONS
  Results of this updated meta-analysis provided evidence to support that acid-suppressive medications were associated with increased risk of fracture, especially hip fracture.
authors: Department of Orthopedics, Drum Tower Hospital, Nanjing University Medical School No. 321 Zhongshan Road, Nanjing, China.
authors: Dawei
authors: D
authors: Cai
authors: Nanjing University Medical School Nanjing, People's Republic of China.
authors: Wan
authors: W
authors: Feng
authors: Department of Orthopedics, Drum Tower Hospital, Nanjing University Medical School No. 321 Zhongshan Road, Nanjing, China.
authors: Qing
authors: Q
authors: Jiang
keywords: Fracture risk; H2RA; PPI; acid-suppressive medication