Proton pump inhibitors - a widely used class of drugs used to treat acid reflux and related symptoms - may lead to an increased risk of fractures in children and adolescents, reports a study in the Journal of Pediatric Gastroenterology and Nutrition (JPGN) . Official journal of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) and the European Society for Paediatric Gastroenterology, Hepatology and Nutrition, JPGN is published by Wolters Kluwer .
"This study suggests an increased risk of fracture among otherwise healthy pediatric patients exposed to PPIs," according to the new research, led by Nathan Robert Fleishman, MD, Children's Mercy Kansas City in Kansas City, Mo. The researchers believe their findings have important implications for the care of children taking PPIs - especially long-term users. As in adults, PPIs may increase fracture risk in children
The study included data on children and adolescents, average age four years, receiving care at 51 US children's hospitals from 2011 to 2015. Data were drawn from the cooperative Pediatric Hospital Information System database. A total of 32,001 care encounters where the patient received a PPI were matched to the same number of encounters without PPI use. The study excluded patients with complex chronic conditions, or with conditions or medications predisposing to fracture risk.
The analysis showed a significantly higher fracture rate in children exposed to PPIs: 1.4 percent, compared to 1.2 percent in those not exposed to PPIs. The authors performed a further analysis to adjust for differences in patient characteristics, including sex, race, insurance status, and type and intensity of care encounter.
In this adjusted analysis, the odds of fracture remained significantly higher in children exposed to PPIs: adjusted odds ratio 1.2. In other words, all other risk factors being equal, the probability of fracture would be 20 percent higher in a child taking PPIs.
In both groups, the upper extremity (arm and hand) was the most common fracture location. However, children exposed to PPIs were more likely to have fractures of the lower extremity (leg and foot), ribs, or spine. In both groups, fractures were most common in one- to three-year and nine-to-13-year age groups. The findings suggested a "class effect" of PPIs: fracture risk was increased with all PPIs, not any particular drug or combination of drugs.
While our findings are statistically significant, the relative risks are small. However, our study design tended to underestimate the actual risk." Nathan Robert Fleishman, MD, Children's Mercy Kansas City in Kansas City Related Stories
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