US: Proton pump inhibitors are widely used to treat acid reflux and other upper intestinal disorders in children as well as adults. Although PPIs have historically been considered "exceptionally safe," several reports have suggested that they may be implicated in a wide range of complications. In adults, PPIs have been linked to a small but significant increase in the risk of fractures, especially with long-term use. But the same complications with PPIs in children is still in a dilemma.

A study suggesting an increased risk of fracture among otherwise healthy pediatric patients exposed to PPIs was conducted by Nathan Robert Fleishman, MD, Children's Mercy Kansas City in Kansas City, Mo. It was published in the Journal of Pediatric Gastroenterology and Nutrition.

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 study included data on children and adolescents, the average age of four years, 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.

Following were the key findings:

1)Significantly higher fracture rate in children exposed to PPIs: 1.4 percent, compared to 1.2 percent in those not exposed to PPIs.

2)The probability of fracture would be 20 per cent higher in a child taking PPIs.

3)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.

4)A "class effect" of PPIs was observed, where the fracture risk was increased with all PPIs, not any particular drug or combination of drugs.

"Our study highlights the need to limit the use of PPIs to individuals who are clearly benefiting and for the least duration necessary," stated the coauthor Thomas Attard, MD. "Additionally, children who are on these medications long-term warrant ongoing follow up." The researchers hope the findings will stimulate further research and strategies to limit fracture risk in children who require PPIs for longer periods of time.

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DOI: 10.1097/MPG.0000000000002690