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Comment & Response
September 28, 2020

Proton Pump Inhibitors and Fractures During Growth—Reply

Author Affiliations
  • 1Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
  • 2Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
JAMA Pediatr. 2021;175(2):209-210. doi:10.1001/jamapediatrics.2020.2570

In Reply We greatly appreciate the comments from Sugiyama on our study1 evaluating the association between proton pump inhibitor (PPI) use and risk of fracture in children. We agree that the results need to be interpreted carefully and that additional research is needed.

Sugiyama points to previous studies and to some of our results to question the possibility of a causal association. First, we would like to underline that causality has not been claimed. Our main finding was a hazard ratio (HR) of 1.11 (95% CI, 1.06-1.15) for the association between PPI use and risk of any fracture in this pediatric cohort. The small relative risk increase definitively warrants careful interpretation of the data and any implications for clinical practice.

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