Hip fracture risk, smoking and anti-ulcer drugs (PPIs)?

@HealthMed A report in the latest British Medical Journal by Chan and his team from the Gastro-enterology Department at the Massachusetts General Hospital in Boston, USA, suggests a small but potentially important higher risk of hip fracture in current or ex-smokers among post-menopausal women on treatment with the commonly used anti-ulcer drugs - proton pump inhibitors. The risk was small - one extra hip fracture per year for every 2000 women treated -but the risk was greater, the longer the treatment with a PPI. 

The link is biologically plausible as both PPIs and smoking have actions on the body which could increase the risk of hip fracture. The authors were careful to state that the risk did not apply to non-smokers and for those at risk they were unable to attribute this to any specific type of PPI. Of note, there are several reasons why smokers are more at risk of causes of indigestion/dyspepsia which may make them more likely than non-smokers to be on PPI treatment.
 
This report is another example illustrating that drug choice and duration should be based on balancing clinical benefit against potential risk of adverse drug effects.
This was an older study among nurses in the US from data collected from 2000 up to 2008.  
A weakness of the study is that it was not a randomised controlled trial. The report was based on following a cohort of people some of whom happened to be on PPI treatment : that means that the findings may be subject to bias ie there may be reasons unrelated to the PPIs to explain the hip fracture risk, although the authors made clear efforts to control for obvious sources of bias.
Patients who are concerned should consult their GP or pharmacist for advice.

See source reference
Khalili H, Huang ES, Jacobson BC, et al. Use of proton pump inhibitors and risk of hip fracture in relation to dietary and lifestyle factors: a prospective cohort study. British Medical Journal. Published online January 31 2012