The most potent medications available for the suppression of gastric acid appear to increase the risks of fractures and bacterial infection in users, according to three separate studies.

One analysis looked at data from 3,396 postmenopausal women (aged 50 to 79 years) participating in the Women’s Health Initiative (Arch Intern Med. 2010;170:765-771). The women were all using a proton pump inhibitor (PPI), some for more than three years.

At baseline, none of the women had ever incurred a hip fracture. After an average follow-up period of 7.8 years, PPI use was not significantly associated with an increased risk of hip fracture but did appear to raise the risk for other fracture outcomes.

Other studies have indicated a higher risk of hip fractures with PPI use, as acknowledged by the FDA in late May when the agency notified health-care professionals and patients of new safety information on the labels of prescription and OTC PPIs, warning of a possible increased risk of hip, wrist, and spine fractures.

In other findings, daily PPI use was associated with an estimated 74% increase in Clostridium difficile infection (Arch Intern Med. 2010;170:784-790), and people using PPIs while being treated for C. difficile ran a 42% increased risk of recurrence (Arch Intern Med. 2010;170:772-778).