Sunday, May 16, 2010
Acid suppressing medication assoc with inc fractures, infections
Proton pump inhibitors are often used to treat dyspepsia, or indigestion, in the absence of ulcers, inflammation or severe GERD. "That proton pump inhibitors relieve dyspepsia is without question, but at what cost (and I do not mean financial)? Five studies in this issue of the Archives help to answer this question."
The studies find that:
Use of proton pump inhibitors appears modestly associated with the risk of total fractures in postmenopausal women. Shelly L. Gray, Pharm.D., M.S., of University of Washington, Seattle, and colleagues studied 161,806 women between ages 50 and 79 in the Women's Health Initiative Study. Over eight years of follow-up, they found no decrease in bone mineral density or increase in risk of hip fractures, but an increased risk of spine and forearm or wrist fractures in addition to total fractures.
Daily proton pump inhibitor use is associated with an estimated 74 percent increase in infection with Clostridium difficile, report Michael D. Howell, M.D., M.P.H., of Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, and colleagues in an analysis of more than 100,000 patients discharged form hospitals in a five-year period. In another report, Amy Linsky, M.D., of Boston Medical Center, and colleagues studied about 1,200 patients being treated for C difficile and found a 42 percent increased risk of recurrence if proton pump inhibitors were used.
High-dose proton pump inhibitors do not appear to be associated with reduced rates of additional bleeding, surgical intervention or death in patients with bleeding ulcers when compared with regular proton pump inhibitor therapy. Chih-Hung Wang, M.D., and colleagues at National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, performed a meta-analysis of seven randomized trials published before August 2009 and involving 1,157 patients. The results did not change when other factors, including severity of recent hemorrhage and the method of medication administration, were considered.
Implementing standardized guidelines based on medical evidence appeared to be associated with reductions in prescriptions for proton pump inhibitors at one facility, report Patrick S. Yachimski, M.D., M.P.H., and colleagues at Massachusetts General Hospital and Harvard Medical School, Boston (and now of Vanderbilt University Medical Center, Nashville). Among a group of 942 patients, the number of inpatients receiving proton pump inhibitor prescriptions decreased from 27 percent before guidelines to 16 percent after, and prescriptions at discharge decreased from 16 percent to 10 percent.