have been confirmed by other similar studies throughout the world [ 21 ].
Furthermore , for the management of GERD , H 2 RAs have proven efficacy [ 22 , 24 ] with intravenous PPI vs H 2 RA showing non-inferiority ( no difference ) in efficacy after 30 and 60mins for signs and symptoms of dyspepsia [ 23 ]. Regardless of the factors that may be associated with PPI use and increased risk of falls , there does appear to be strong link from the evidence presented between PPI use and increased risk of falls and fractures in the elderly population . Both the New Zealand Formulary [ 25 ] and the Health Quality and Safety Commission of New Zealand [ 26 ] has linked and cautions the use of PPIs as a risk factor for increased falls in the elderly .
Given the emerging evidence to date , the overuse of PPIs in the elderly needs to be curtailed and the benefits weighed up against the potential for harm [ 5,18,23 ].
Many elderly patients can be managed on H 2 RAs and as these are considered to be clinically safer ( for many decades of evidence ). They should be considered for all patients indicated for acid suppression , especially longterm [ 1,19,20 ]. Nevertheless , indications , dosages and duration of use need to be reviewed for both drug classes in all patients . There needs to be frequent educational sessions for general practitioners and nurses to increase awareness of the adverse effects associated with use of PPIs in the elderly , especially longer term usage greater than four weeks .
References :
1 . Andersen B , Johansen P , Abrahamsen B . Proton pump inhibitors and osteoporosis . Current Opinion in Rheumatology . ( 2016 , July ); 28 ( 4 ): 420-425 . 2 . Zhou B , Huang Y , Li H ,
Sun W , Liu J . Protonpump inhibitors and risk of fractures : an update meta-analysis . Osteoporosis International ( 2016 , January ), 27 ( 1 ): 339-47 .
3 . Adams A , Black M , Zhang J , Shi J , Jacobsen S . Proton-pump inhibitor use and hip fractures in men : a population-based casecontrol study . Annals of Epidemiology . ( 2014 , Apr ); 24 ( 4 ): 286-290 .
4 . Yang YX , Lewis JD , Epstein S , Metz DC . Long-term proton-pump inhibitor therapy and risk of hip fracture . Journal of the American Medical Association . ( 2006 Dec ) 27 ; 296 ( 24 ): 2947-53 .
5 . Thaler H , Sterke C , Van Der Cammen T . Association of proton pump inhibitor use with recurrent falls and risk of fractures in older women : A study of medication use in older
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