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Proton Pump Inhibitor Therapy and Hip Fracture Risk—Reply
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In Reply: We disagree with the suggestion of Drs Geller and Adams that our observed association between PPI use and hip fracture may be confounded by the pandemic of vitamin D deficiency. By definition, a confounder must not only be associated with the disease of interest, it must also be associated with the exposure under study, and it must not be affected by the exposure or the disease.1 Geller and Adams support their concern about confounding of the association between gastric acid suppression and hip fractures by citing evidence of vitamin D status as a risk factor for hip fractures. However, by not considering how PPI therapy might relate to vitamin D status, they ignored 2 of the 3 essential elements that characterize a confounder.
We are not aware of any data that suggest that PPI use may cause or exacerbate vitamin D deficiency. Our search of the literature did . . . [Full Text of this Article]
Yu-Xiao Yang, MD, MSCE
yangy@mail.med.upenn.edu
James D. Lewis, MD, MSCE
Division of Gastroenterology
University of Pennsylvania School of Medicine
Philadelphia
Solomon Epstein, MD
Doylestown Hospital Research Center
Doylestown, Pa
David C. Metz, MD
Division of Gastroenterology
University of Pennsylvania School of Medicine
Philadelphia
RELATED LETTER
Proton Pump Inhibitor Therapy and Hip Fracture Risk
Jordan L. Geller and John S. Adams
JAMA. 2007;297(13):1429.
EXTRACT
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RELATED ARTICLE
Long-term Proton Pump Inhibitor Therapy and Risk of Hip Fracture
Yu-Xiao Yang, James D. Lewis, Solomon Epstein, and David C. Metz
JAMA. 2006;296(24):2947-2953.
ABSTRACT
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