Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.

Increased Fracture Rates among Female Osteoporosis Patients Taking Oral Bisphosphonates and Proton Pump Inhibitors Concurrently.

Agashivala1,  Neetu, Chan2,  Wing

Novartis Pharmaceuctical Corp, East Hanover, NJ
Novartis Pharmaceuctical Corp


Oral bisphosphonates can cause upset stomach and inflammation, and erosions of the esophagus. Oesophageal and stomach symptoms have been reported in patients taking oral bisphosphonates which may require proton pump inhibitor (PPI) therapy. However, PPIs may interfere with calcium absorption through induction of hypochlorhydria resulting in increased bone resorption. Recent epidemiologic studies have also found that people receiving high doses of PPIs or using them for one year or more are at an increased risk of fractures of the hip, wrist, and spine. The objective of this study was to determine the fracture rates among female osteoporosis patients taking oral bisphosphonates and PPI therapy.


A retrospective database analysis was conducted using the commercial and Medicare data from the MarketScan claims database for year 2005–06. All osteoporosis females age 50 years or above currently on oral bisphosphonates (alendronate or risedronate) for at least 90 days were included in this study. These patients were stratified into two groups based on PPI intake. The PPI group included lansoprazole, esomeprazole, omeprazaole, pantoprazole, and rabeprazole. PPI usage was defined as concurrent use of bisphosphonates and PPIs for 90 days or more. Combined fracture rates for hip, vertebral, and non-vertebral fractures were assessed among the two groups. Chi square analysis was performed by age categories using SAS software, version [8.2] of the SAS system for Windows.


Of the 153,899 female osteoporosis patients age 50 and above taking oral bisphosphonates that were identified in the database, 28,304 were taking PPI concurrently. There were a total of 13,388 patients who had experienced a fracture, 3,780 in the PPI group and 9,608 in the non-PPI group. The chi square analysis showed that there was an increased fracture risk in the PPI group compared to the non-PPI group by all age groups (cmh=1.7044; p<.0001). The odds ratio were 1.8216, 1.9074, 1.6091, and 1.5166 in the >=50 and <65, >=65 and <75, >=75 and <85 and >=85 respectively (p<.0001).


PPIs appear to be associated with an increased fracture risk among female osteoporosis patients taking oral bisphosphonates. Further research in the area is required using case-control cohorts.

To cite this abstract, please use the following information:
Agashivala, Neetu, Chan, Wing; Increased Fracture Rates among Female Osteoporosis Patients Taking Oral Bisphosphonates and Proton Pump Inhibitors Concurrently. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :2089
DOI: 10.1002/art.29854

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