Department of Gastroenterology, Levine Children's Hospital, Charlotte, North Carolina, USA.
Children's Hospital Association, Lenexa, Kansas, USA.
Curr Med Res Opin. 2022 Apr;38(4):565-570. doi: 10.1080/03007995.2022.2037847. Epub 2022 Feb 25.
Histamine 2 receptor antagonists (H2RA) are amongst the most entrenched antacid therapies available including over-the-counter. They have an excellent safety profile including no known teratogenic risk. Fracture risk is generally recognized with chronic proton pump inhibitor (PPI) therapy in adults and children although the related mechanism is poorly understood. The analogous risk in H2RAs, including in children, is unclear. We studied the fracture risk and characteristics among hospitalized pediatric patients exposed to H2RA compared to an untreated cohort.
The Pediatric Health Information System (PHIS) multicenter database was queried for hospital encounters of children aged 6 months - 15.5 years and between 7/2016 and 8/2017. Patients with comorbidities and medications including PPI that predispose for fractures were excluded from the cohort and a propensity-matched control was identified. The subjects and controls were followed for 2 years for hospitalization with fracture diagnoses.
Our cohort included 3526 patients with exposure to H2RA and matched controls. Fractures were reported in 1% of patients (67) with no statistical difference between the groups. Upper, then lower extremity fractures were the most common in both groups. Axial skeleton fractures were the least frequently encountered fractures among both groups.
H2RA exposure is not associated with an increased risk of fracture in hospitalized children exposed to H2RA when compared with a matched untreated cohort, further studies are needed to determine if long-term exposure to H2RA may be associated with fracture risk in both those with and without comorbidities or on fracture predisposing medication.
组胺 2 受体拮抗剂（H2RA）是最常用的抗酸治疗药物之一，包括非处方药物。它们具有极好的安全性，没有已知的致畸风险。成人和儿童长期使用质子泵抑制剂（PPI）治疗一般会导致骨折风险增加，尽管相关机制尚不清楚。H2RA 包括儿童在内的骨折风险尚不清楚。我们研究了与未接受治疗的队列相比，接受 H2RA 治疗的住院儿科患者的骨折风险和特征。
使用多中心儿科健康信息系统（PHIS）数据库，对 2016 年 7 月至 2017 年 8 月期间年龄在 6 个月至 15.5 岁的住院患儿进行了调查。从队列中排除了患有合并症和易导致骨折的药物（包括 PPI）的患者，并确定了匹配的对照组。对研究对象和对照组进行了 2 年的随访，以观察骨折住院诊断。
我们的队列包括 3526 例接受 H2RA 治疗的患者和匹配的对照组。有 1%（67 例）的患者报告有骨折，两组之间无统计学差异。上肢骨折，然后是下肢骨折，是两组中最常见的骨折。两组中轴向骨骼骨折最少见。
与未接受治疗的匹配对照组相比，接受 H2RA 治疗的住院儿童骨折风险并未增加，还需要进一步研究以确定长期暴露于 H2RA 是否与合并症或骨折易患药物的患者和无合并症或骨折易患药物的患者的骨折风险相关。
