Use of acid-suppressive drugs and risk of fracture in children and young adults: a meta-analysis of observational studies

Background: Recent studies have suggested that proton pump inhibitors (PPIs) and histamine type 2 receptor antagonists (H2RAs) may increase the risk of fracture. We performed a meta-analysis to evaluate the risk of fracture with PPIs and H2RAs use in children and young adults.Methods: PubMed, EMBASE database, Cochrane Library, and Web of Science for relevant articles published before May 2021 were searched. We included all the observational studies reporting on the risk of fracture with acid-suppressive drug (PPIs and H2RAs) use in children and young adults. We calculated pooled risk ratios (RRs) for fracture using random-effects models and conducted subgroup analyses.Results: A total of six studies were included in our analysis. Pooled analysis of PPIs use showed significant risk for fracture (RR = 1.23; 95% CI, 1.12–1.34; I2 = 79.3), but not significant for PPIs combined with H2RAs use (RR = 1.22; 95% CI, 0.94–1.60; I2 = 44.0%), as well as for H2RAs use alone (RR = 1.08; 95% CI, 0.94-1.24; I2 = 84.1%). Grouping of studies by region showed a significantly increased fracture risk with PPIs use in North America (RR = 1.24; 95% CI, 1.16–1.32; I2 =0.0%) than in Europe (RR = 1.23; 95% CI, 1.00–1.52; I2 = 94.6%) and Asia (RR = 1.10; 95% CI, 0.96–1.25). However, there was no significant association between the H2RAs use and the fracture risk in North America (RR = 1.08; 95% CI, 1.00–1.09; I2 = 0.0%). Moreover, PPIs use showed an increased risk of fracture in women (RR = 1.13; 95% CI, 1.07–1.19; I2 = 0.0%), whereas there was no significant association between the PPIs use and the risk of fracture in men (RR = 0.93; 95% CI, 0.66–1.31; I2 = 0.0%).Conclusion: PPIs use alone could increase the risk of fracture in children and young adults, but not for PPIs combined with H2RAs use or H2RAs use alone. Clinicians should exercise caution when prescribing PPIs for patients.

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ADRB2 Haplotypes and Asthma Exacerbations in Children and Young Adults: An Individual Participant Data Meta‐Analysis

Clinical & Experimental Allergy ◽

10.1111/cea.13965 ◽

2021 ◽

Author(s):

Leila Karimi ◽

Susanne J. Vijverberg ◽

Marjolein Engelkes ◽

Natalia Hernandez‐Pacheco ◽

Niloufar Farzan ◽

...

Keyword(s):

Young Adults ◽

Meta Analysis ◽

Individual Participant Data ◽

Asthma Exacerbations ◽

Individual Participant ◽

Children And Young Adults

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“Which skeletal imaging modality is best for assessing bone health in children and young adults compared to DXA? A systematic review and meta-analysis”

Bone ◽

10.1016/j.bone.2021.116013 ◽

2021 ◽

pp. 116013

Author(s):

Heba Shalof ◽

Paul Dimitri ◽

Farag Shuweihdi ◽

Amaka C. Offiah

Keyword(s):

Systematic Review ◽

Young Adults ◽

Bone Health ◽

Imaging Modality ◽

Meta Analysis ◽

Children And Young Adults

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Incidence and mortality rates of intracranial hemorrhage in hemophilia: a systematic review and meta-analysis

Blood ◽

10.1182/blood.2021011849 ◽

2021 ◽

Author(s):

Anne-Fleur Zwagemaker ◽

Samantha C Gouw ◽

Julie J Jansen ◽

Caroline Vuong ◽

Michiel Coppens ◽

...

Keyword(s):

Systematic Review ◽

Young Adults ◽

Intracranial Hemorrhage ◽

Meta Analysis ◽

Age Groups ◽

Mortality Rates ◽

Normal Model ◽

Live Births ◽

Incidence And Mortality ◽

Children And Young Adults

Intracranial hemorrhage (ICH) is a severe complication that is relatively common among hemophilia patients. This systematic review aimed to obtain more precise estimates of ICH incidence and mortality in hemophilia, which may be important for patients, caregivers, researchers and health policy-makers. PubMed and EMBASE were systematically searched using terms related to "hemophilia" and "intracranial hemorrhage" or "mortality". Studies that allowed calculation of ICH incidence or mortality rates in a hemophilia population of at least 50 patients were included. We summarized evidence on ICH incidence and calculated pooled ICH incidence and mortality in three age groups: (1) persons of all ages with hemophilia, (2) children and young adults below 25 years of age with hemophilia and (3) neonates with hemophilia. Incidence and mortality were pooled with a Poisson-Normal model or a Binomial-Normal model. We included 45 studies that represented 54 470 patients, 809 151 person-years and 5326 live births of hemophilia patients. In persons of all ages, the pooled ICH incidence and mortality rates were 2.3 (95% CI 1.2-4.8) and 0.8 (95% CI 0.5-1.2) per 1000 person-years, respectively. In children and young adults, the pooled ICH incidence and mortality rates were 7.4 (95% CI 4.9-11.1) and 0.5 (95% CI 0.3-0.9) per 1000 person-years, respectively. In neonates, the pooled cumulative ICH incidence was 2.1% (95% CI 1.5-2.8) per 100 live births. ICH was classified as spontaneous in 35-58% of cases. Our findings suggest that ICH is an important problem in hemophilia that occurs among all ages, requiring adequate preventive strategies.

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Risk of Fracture in Type 2 Diabetes Mellitus Patients: Meta-Analysis of Observational Studies

Value in Health ◽

10.1016/j.jval.2015.09.2062 ◽

2015 ◽

Vol 18 (7) ◽

pp. A601 ◽

Cited By ~ 2

Author(s):

C Shah ◽

R Shah ◽

G Kinra ◽

S Singuru ◽

M Naidu ◽

...

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Observational Studies ◽

Meta Analysis ◽

Risk Of Fracture

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Harms of Antipsychotics in Children and Young Adults: A Systematic Review Update

The Canadian Journal of Psychiatry ◽

10.1177/0706743718779950 ◽

2018 ◽

Vol 63 (10) ◽

pp. 661-678 ◽

Cited By ~ 6

Author(s):

Jennifer Pillay ◽

Khrista Boylan ◽

Amanda Newton ◽

Lisa Hartling ◽

Ben Vandermeer ◽

...

Keyword(s):

Systematic Review ◽

Young Adults ◽

Weight Gain ◽

Meta Analysis ◽

Extrapyramidal Symptoms ◽

Short Term ◽

Strength Of Evidence ◽

Cholesterol Levels ◽

Children And Young Adults ◽

Meta Analyses

Objective: To update and extend our previous systematic review on first- (FGAs) and second-generation antipsychotics (SGAs) for treatment of psychiatric and behavioral conditions in children, adolescents, and young adults (aged ≤24 years). This article focuses on the evidence for harms. Method: We searched (to April 2016) 8 databases, gray literature, trial registries, Food and Drug Administration reports, and reference lists. Two reviewers conducted study screening and selection independently, with consensus for selection. One reviewer extracted and another verified all data; 2 reviewers independently assessed risk of bias. We conducted meta-analyses when appropriate and network meta-analysis across conditions for changes in body composition. Two reviewers reached consensus for ratings on the strength of evidence for prespecified outcomes. Results: A total of 135 studies (95 trials and 40 observational) were included, and 126 reported on harms. FGAs caused slightly less weight gain and more extrapyramidal symptoms than SGAs. SGAs as a class caused adverse effects, including weight gain, high triglyceride levels, extrapyramidal symptoms, sedation, and somnolence. They appeared to increase the risk for high cholesterol levels and type 2 diabetes. Many outcomes for individual drug comparisons were of low or insufficient strength of evidence. Olanzapine caused more short-term gains in weight and body mass index than several other SGAs. The dose of SGAs may not make a difference over the short term for some outcomes. Conclusions: Clinicians need to weigh carefully the benefit-to-harm ratio when using antipsychotics, especially when treatment alternatives exist. More evidence is needed on the comparative harms between antipsychotics over the longer term.

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