Overprescribing proton pump inhibitors

Dear Editor,

Forgacs & Loganayagam discuss the over prescribing of proton pump
inhibitors (PPI) in clinical practice (1). However, we would like to point
out that PPIs are not a recognised cause of osteoporosis, as stated in
this editorial. The cited article by Yang et al.(2) found that chronic use
of proton pump inhibitors (PPI) was associated with increased risk of hip
fracture, consistent with other studies linking their use to increased
fracture risk (3,4,5).

This association is particularly relevant to the management of
osteoporosis as bisphosphonates, the most common group of medications
prescribed for patients with osteoporosis, are associated with upper
gastro-intestinal effects, such as dyspepsia (6,7), which may lead to
additional prescribing of PPIs (8). Therefore, minimising the use of PPIs
should also be an important consideration in the management of
osteoporotic patients.

Yours faithfully,

Dr Alun Cooper

REFERENCES

1.Forgacs I, Loganayagam A. Overprescribing of proton pump
inhibitors. BMJ 2008; 336:2-3. (5 January).
2.Yang Y-X, Lewis JD, Epstein S, Metz DC. Long-term proton pump inhibitor
therapy and risk of hip fracture. JAMA 2006; 296 (24), 2947-2953.
3.Vestergaard P, Rejnmark L, Mosekilde L. Proton pump inhibitors,
histamine H2 receptor antagonists, and other antacid medication and the
risk of fracture. Calcif Tissue Int. 2006; 79, 76-83.
4.Yu E W, Shinoff C, Blackwell T, Ensrud K, Hillier T, Bauer D C. Use of
acid-suppressive medications and risk of bone loss and fracture in
postmenopausal women. J Bone Min Res 2006; 21 (Suppl. 1), S281.
5.De Vries F, Cooper AL, Logan RF, Cockle SM, van Staa TP, Cooper C.
Fracture risk in patients receiving concomitant bisphosphonate and acid-
suppressive medication or bisphosphonates alone. Osteoporosis Int. 2007;
18(Suppl 3):S261.
6.Barrera BA, Wilton LV, Harris S, Shakir SAW. Prescription-event
monitoring study on 13,164 patients prescribed risedronate in primary care
in England. Osteoporos Int. 2005; 16, 1989-1998.
7.Biswas PN, Wilton LV, Shakir SAW. Pharmacovigilance study of alendronate
in England. Osteoporos Int. 2003; 14, 507-514.
8.Roughead EE, McGeechan K, Sayer GP. Bisphosphonate use and subsequent
prescription of acid suppressants. Br J Clin Pharm. 2004; 57(6), 813-816.

Competing interests:
None declared