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Proton pump inhibitors’ use and risk of hip fracture: a systematic review and meta-analysis

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Abstract

In the last decade, epidemiological studies presented inconsistent findings concerning the proton pump inhibitors (PPI) use and the risk of hip fracture. So, this systematic review and meta-analysis were performed with the aim to quantify the risk of hip fracture associated with PPI use. PubMed® and Cochrane Central databases were searched from inception to January 2018. The quality of included studies in meta-analysis was assessed using Newcastle-Ottawa scale. Primary outcome of this study was to assess the risk of hip fracture among PPI user. Secondary outcomes include subgroup analysis based on study design, study quality, duration of PPI use, calcium intake, and geographical region. Sensitivity analysis was also performed. Review Manager (RevMan) was used to perform statistical analysis. This meta-analysis was based on seventeen studies. Pooled risk ratio showed a statistically significant association between PPI use and hip fracture risk (RR 1.26 [95% CI 1.17–1.35], p < 0.00001). Subgroup analysis, based on the study design, showed a highly significant association between PPI use and risk of hip fracture (p < 0.0001). The risk of hip fracture persisted even when stratified by calcium adjustment and the duration of PPI use (p < 0.0001). 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.

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Acknowledgements

First author (Salman Hussain) are grateful to Sun Pharmaceuticals, India, for providing assistance for this project under the joint collaboration for PhD programme with School of Pharmaceutical Education and Research (SPER), Jamia Hamdard, New Delhi, India. Authors are thankful to Dr. Mohd Vaseem Ismail, Assistant Professor at Jamia Hamdard, New Delhi, India for providing his statistical inputs during the manuscript preparation.

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Authors and Affiliations

  1. Department of Pharmaceutical Medicine (Division of Pharmacology), School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi, 110062, India

    Salman Hussain & Ali Nasir Siddiqui

  2. Department of Medicine, Hamdard Institute of Medical Sciences and Research, Jamia Hamdard, New Delhi, India

    Anwar Habib

  3. Department of Pharmacognosy, Faculty of Pharmacy, Misurata University, Misurata, Libya

    Md. Sarfaraj Hussain

  4. Department of Pharmacology, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi, 110062, India

    Abul Kalam Najmi

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  1. Salman Hussain
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  2. Ali Nasir Siddiqui
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  5. Abul Kalam Najmi
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Contributions

SH and AKN designed the study. SH and ANS searched databases and performed the selection of the studies; SH and MSH completed the data extraction; SH and AH performed the quality assessment of the included studies; SH and ANS wrote the manuscript; SH analyzed and interpreted the data. All authors have reviewed and revised the draft critically for intellectual content. All authors give final approval of the version to be submitted in journal.

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Correspondence to Abul Kalam Najmi.

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Hussain, S., Siddiqui, A.N., Habib, A. et al. Proton pump inhibitors’ use and risk of hip fracture: a systematic review and meta-analysis. Rheumatol Int 38, 1999–2014 (2018). https://doi.org/10.1007/s00296-018-4142-x

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