Tuesday, June 2, 2009
News from Digestive Disease Week: PPIs and CAT
CHICAGO--Is there a link between acid-reducing meds and hip fractures?
A new study released here today reports that taking even less than one proton pump inhibitor (PPI) or histamine-2 receptor antagonist (H2RA) could increase your patients' risk of hip fractures.
Fracture risk rose 12% for those taking less than one pill a day, 30% for those taking the usual dose of one pill a day, and 41% for those taking more than one pill a day among patients studied at the northern California Kaiser Permanente integrated health-services organization. Patients with hip fractures were 30% more likely than controls to have taken PPIs and 18% were more likely to have taken H2RAs for at least two years.
While risk seemed greatest among patients 50-59 years old, the greatest number of fractures was among the 80- to 89-year-old group, which had a lower PPI-relative risk.
"Patients taking acid suppressors should continue treatment at the lowest effective dose. However, they should discuss treatment options with their doctor if they are at risk of osteoporosis," said Douglas A. Corley, MD, of Kaiser Permanente in San Francisco, and the study's lead investigator. The study looked at up to 10 years of exposure to PPIs and H2RAs for 33,752 cases.
New CAT cautions: The risks of giving complex antithrombotic therapy (CAT) to your patients may be higher than you think.
New data released here today shows that veterans aged 60-99 who were prescribed aspirin-antiplatelet therapy or aspirin-anticoagulant therapy were two to two-and-a-half times more likely to suffer significant upper gastrointestinal events (UGIE) like bleeding or perforation. The least harmful CAT combination was anticoagulant-antiplatelet therapy.
However, younger patients (those between ages 60 and 69) who received CAT were at highest risk of experiencing UGIE, and their risk of bleeding within one year of taking the drugs was four times higher. These patients were likely to be on aspirin-anticoagulant-antiplatelet therapy for a history of ischemic heart disease, hypertension, diabetes, and peripheral artery disease.
"The observed magnitude of UGIE risk suggests an unfavorable risk/benefit profile for CAT in the short term," says Neena S. Abraham, MD, lead investigator of the study, conducted with the Michael E. DeBakey VA Medical Center and Baylor College of Medicine in Houston. The study was conducted from Jan. 1, 2003 to Sept. 30, 2006.
--By Paula Katz, special to ACP Internist
Labels: digestive disease week, fractures, ppi
posted by Janet Colwell at
10:00 AM
Contact ACP Internist
Send comments to ACP Internist staff at acpinternist@acponline.org.
Previous Posts
- News from Digestive Disease Week: Crohn's disease
- News from Digestive Disease Week: Patients often i...
- Digestive Disease Week: Colorectal cancer detectio...
- Medical news of the obvious
- Superbug threat lurks in sewer
- Doctors discuss the consequences of misleading med...
- Watch out, bad doctors.
- Who's referring who?
- Medical news of the obvious
- How to annoy a reporter
Blog log
Members of the American College of Physicians contribute posts from their own sites to ACP Internist and ACP Hospitalist. Contributors include:
Albert Fuchs, MD
Albert Fuchs, MD, FACP,
graduated from the University of California, Los Angeles School of
Medicine, where he also did his internal medicine training.
Certified by the American Board of Internal Medicine, Dr. Fuchs
spent three years as a full-time faculty member at UCLA School of
Medicine before opening his private practice in Beverly Hills in
2000.
David Katz, MD
David L. Katz, MD, MPH, FACP, is an internationally renowned
authority on nutrition, weight management, and the prevention of
chronic disease, and an internationally recognized leader in
integrative medicine and patient-centered care.
DrDialogue
Juliet K. Mavromatis, MD, FACP, provides a conversation about
health topics for patients and health professionals.
Dr. Mintz' Blog
Matthew Mintz, MD, FACP, has practiced internal medicine for more
than a decade and is an Associate Professor of Medicine at an
academic medical center on the East Coast. His time is split
between teaching medical students and residents, and caring for
patients.
Everything Health
Toni Brayer, MD, FACP, blogs about the rapid changes in science,
medicine, health and healing in the 21st century.
FutureDocs
Vineet Arora, MD, FACP, is Associate Program Director for the
Internal Medicine Residency and Assistant Dean of Scholarship &
Discovery at the Pritzker School of Medicine for the University of
Chicago. Her education and research focus is on resident duty
hours, patient handoffs, medical professionalism, and quality of
hospital care. She is also an academic hospitalist.
Glass
Hospital
John H. Schumann, MD, FACP, provides transparency on the workings
of medical practice and the complexities of hospital care,
illuminates the emotional and cognitive aspects of caregiving and
decision-making from the perspective of an active primary care
physician, and offers behind-the-scenes portraits of hospital
sanctums and the people who inhabit them.
Gut Check
Ryan Madanick, MD, ACP Member, is a gastroenterologist at the
University of North Carolina School of Medicine, and the Program
Director for the GI & Hepatology Fellowship Program. He
specializes in diseases of the esophagus, with a strong interest in
the diagnosis and treatment of patients who have
difficult-to-manage esophageal problems such as refractory GERD,
heartburn, and chest pain.
I'm dok
ACP Member Mike Aref, MD, PhD, ACP Member, is an academic
hospitalist with an interest in basic and clinical science and
education, with interests in noninvasive monitoring and diagnostic
testing using novel bedside imaging modalities, diagnostic
reasoning, medical informatics, new medical education modalities,
pre-code/code management, palliative care, patient-physician
communication, quality improvement, and quantitative biomedical
imaging.
Just Oncology
Richard Just, MD, ACP Member, has 36 years in clinical practice of hematology and medical oncology. His blog is a joint publication with Gregg Masters, MPH.
KevinMD
Kevin Pho, MD, ACP Member, offers one of the Web's definitive sites
for influential health commentary.
MD
Whistleblower
Michael Kirsch, MD, FACP, addresses the joys and challenges of
medical practice, including controversies in the doctor-patient
relationship, medical ethics and measuring medical quality. When
he's not writing, he's performing colonoscopies.
Medical
Lessons
Elaine Schattner, MD, ACP Member, shares her ideas on education,
ethics in medicine, health care news and culture. Her views on
medicine are informed by her past experiences in caring for
patients, as a researcher in cancer immunology, and as a patient
who's had breast cancer.
Prescriptions
David M. Sack, MD, FACP, practices general gastroenterology at a
small community hospital in Connecticut. His blog is a series of
musings on medicine, medical care, the health care system and
medical ethics, in no particular order.
Reflections
of a Grady Doctor
Kimberly Manning, MD, FACP, reflects on the personal side of being
a doctor in a community hospital in Atlanta.
Technology in (Medical) Education
Neil Mehta, MBBS, MS, FACP, is interested in use of technology in
education, social media and networking, practice management and
evidence-based medicine tools, personal information and knowledge
management.
White Coat Underground
Peter A. Lipson, MD, ACP Member, is a practicing internist and
teaching physician in Southeast Michigan. The blog, which has been
around in various forms since 2007, offers musings on the
intersection of science, medicine, and culture.
ACP Internist and ACP Hospitalist also contribute to and draw upon content from Get Better Health, a network created by Val Jones, MD, to support and promote health care professional bloggers, provide insightful and trustworthy health commentary, and help to inform health policy makers about the clinician's point of view on health care reform, science, research and patient care.
Other blogs of note:
American
Journal of Medicine
Also known as the Green Journal, the American Journal of Medicine
publishes original clinical articles of interest to physicians in
internal medicine and its subspecialities, both in academia and
community-based practice.
Clinical Correlations
A collaborative medical blog started by Neil Shapiro, MD, ACP
Member, associate program director at New York University Medical
Center's internal medicine residency program. Faculty, residents
and students contribute case studies, mystery quizzes, news,
commentary and more.
db's Medical
Rants
Robert M. Centor, MD, FACP, contributes short essays contemplating
medicine and the health care system.
Interact
MD
Michael Benjamin, MD, ACP member, doesn't accept industry money so
he can create an independent, clinician-reviewed space on the
Internet for physicians to report and comment on the medical news
of the day.
PLoS
Blog
The Public Library of Science's open access materials include a
blog.
White Coat Rants
One of the most popular anonymous blogs written by an emergency
room physician.
0 Comments:
Post a Comment
Subscribe to Post Comments [Atom]
<< Home