医師の一分

アクセスカウンタ

zoom RSS プロトンポンプ阻害薬による骨折リスクの増加

<<   作成日時 : 2011/05/16 23:08   >>

なるほど(納得、参考になった、ヘー) ブログ気持玉 2 / トラックバック 0 / コメント 0

 新たな分析によれば、胃酸逆流症状に対する薬剤のプロトンポンプ阻害薬を使っている人は骨折をしやすいというデータが増加している。従来の薬剤であるヒスタミン2受容体阻害剤ではそうしたリスクの増加は見られなかった。
 昨年FDAは、プロトンポンプ阻害薬PPIが骨折リスクを増加させる可能性があるとの警告ラベル改訂をした。長期服用者で骨折リスクが増加することから、3月に、短期服用の処方箋なしで買えるPPIの警告からは削除された。
 新たな分析研究ではPPI服用患者は29%骨折しやすいとわかった。長期服用では30%以上のリスク増加があり、多量服用では股関節骨折が53%増加するという。
 腸でのカルシウム吸収能力に影響している可能性があるという。

-----------------------------------------------------
Risks: Acid Reflux Drugs Tied to Bone Fractures
By RONI CARYN RABIN
Published: May 13, 2011
http://www.nytimes.com/2011/05/17/health/research/17risks.html

A new analysis adds to growing evidence that people using proton pump inhibitors to control symptoms of acid reflux are more likely to fracture bones than those who do not.

The analysis did not find a similar increase in fracture risk among patients taking older acid reflux medications, called histamine-2 receptor antagonists.

Last year, the Food and Drug Administration revised the label on proton pump inhibitors, or P.P.I.’s, to warn that they may raise the risk of fractures. In March, it removed the warnings from nonprescription P.P.I.’s, saying those were meant only for short courses of treatment while the fracture risk had been observed in long-term users.

The new analysis, published in the May-June issue of Annals of Family Medicine, examined 11 studies and found that patients taking P.P.I.’s were 29 percent more likely to get fractures.

The researchers also found that long-term users were 30 percent more likely to get fractures, and those taking high doses were 53 percent more likely to get hip fractures in particular.

Dr. Seung-Kwon Myung, a staff physician and senior scientist at the National Cancer Center in Seoul, South Korea, and one of the paper’s authors, said P.P.I. treatment may affect the intestine’s ability to absorb calcium. “Long-term or frequent use of P.P.I.’s should be avoided,” he said.

-----------------------------------------------------
Annals of Family Medicine 9:257-267 (2011)
(c) 2011 Annals of Family Medicine, Inc.
doi: 10.1370/afm.1243

画像Use of Acid-Suppressive Drugs and Risk of Fracture: A Meta-analysis of Observational Studies
Chun-Sick Eom, MD, MPH1, Sang Min Park, MD, MPH, PhD1, Seung-Kwon Myung, MD, MS1,2, Jae Moon Yun, MD1 and Jeong-Soo Ahn, MD, MS1

1 Department of Family Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
2 Cancer Epidemiology Branch and Center for Cancer Prevention and Detection, Research Institute and Hospital, National Cancer Center, Goyang, Republic of Korea

CORRESPONDING AUTHORS,*: Sang Min Park, MD, MPH, PhD, Department of Family Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehangno, Jongno-gu Seoul, 110-744, Republic of Korea, sangmin.park.snuh@gmail.com
Seung-Kwon Myung, MD, MS, Cancer Epidemiology Branch and Center for Cancer Prevention and Detection Research Institute and Hospital, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu Goyang, Gyeonggi 410-769, Republic of Korea, msk@ncc.re.kr

PURPOSE Previous studies have reported inconsistent findings regarding the association between the use of acid-suppressive drugs such as proton pump inhibitors (PPIs) and histamine 2 receptor antagonists (H2RAs) and fracture risk. We investigated this association using meta-analysis.

METHODS We searched MEDLINE (PubMed), EMBASE, and the Cochrane Library from inception through December 2010 using common key words. We included case-control, nested case-control, and cohort studies. Two evaluators independently reviewed and selected articles. We determined pooled effect estimates by using random-effects meta-analysis, because of heterogeneity.

RESULTS Of 1,809 articles meeting our initial inclusion criteria, 5 case-control studies, 3 nested case-control studies, and 3 cohort studies were included in the final analyses. The pooled odds ratio (OR) for fracture was 1.29 (95% confidence interval [CI], 1.18--1.41) with use of PPIs and 1.10 (95% CI, 0.99--1.23) with use of H2RAs when compared with nonuse of the respective medications. Long-term use of PPIs increased the risk of any fracture (adjusted OR = 1.30; 95% CI, 1.15--1.48) and hip fracture risk (adjusted OR = 1.34; 95% CI, 1.09--1.66), whereas long-term H2RA use was not significantly associated with fracture risk.

CONCLUSIONS We found possible evidence linking PPI use to an increased risk of fracture, but no association between H2RA use and fracture risk. Widespread use of PPIs with the potential risk of fracture is of great importance to public health. Clinicians should carefully consider their decision to prescribe PPIs for patients already having an elevated risk of fracture because of age or other factors.

Key Words: Proton pump inhibitors . H2-receptor antagonists . fracture risk . meta-analysis


テーマ

関連テーマ 一覧


月別リンク

ブログ気持玉

クリックして気持ちを伝えよう!
ログインしてクリックすれば、自分のブログへのリンクが付きます。
→ログインへ
気持玉数 : 2
なるほど(納得、参考になった、ヘー) なるほど(納得、参考になった、ヘー)

トラックバック(0件)

タイトル (本文) ブログ名/日時

トラックバック用URL help


自分のブログにトラックバック記事作成(会員用) help

タイトル
本 文

コメント(0件)

内 容 ニックネーム/日時

コメントする help

ニックネーム
本 文
プロトンポンプ阻害薬による骨折リスクの増加 医師の一分/BIGLOBEウェブリブログ
文字サイズ:       閉じる