Researchers studied over 410,000 patients who had surgery to fix broken bones and found that people taking proton pump inhibitors (PPIs)—common medications for acid reflux and heartburn—had a harder time healing from their fractures. The risk was especially high for breaks in the lower leg and forearm, and younger patients seemed to be affected the most. While these medications are important for managing stomach problems, this study suggests doctors and patients should be aware of this potential side effect when deciding on treatment plans.

The Quick Take

  • What they studied: Whether heartburn medications called proton pump inhibitors (PPIs) affect how well broken bones heal after surgery
  • Who participated: Over 410,000 patients who had surgery to fix broken bones in their arms or legs between 2015 and 2023. Researchers carefully matched patients taking PPIs with similar patients not taking them to make fair comparisons
  • Key finding: Patients taking PPIs were about twice as likely to have problems with bone healing, especially for breaks in the lower leg and forearm. Young adults (ages 18-44) with lower leg breaks had the highest risk—about 11 times more likely to have healing problems
  • What it means for you: If you take heartburn medication and need surgery for a broken bone, talk to your doctor about whether you should continue or adjust your medication. This doesn’t mean you should stop taking PPIs on your own, but it’s important information for your healthcare team to consider

The Research Details

This was a retrospective cohort study, which means researchers looked back at medical records from patients who had already received treatment. They used a large database called TriNetX that includes information from many hospitals and clinics across the country. The study included patients who had surgery between 2015 and 2023 to fix broken bones in four common locations: the upper arm bone (humerus), forearm bones (radius and ulna), thighbone (femur), and lower leg bones (tibia and fibula).

To make sure they were comparing similar patients, researchers used a technique called propensity score matching. This is like creating two identical groups—one taking PPIs and one not taking them—except for the medication difference. They balanced the groups by age, sex, race, weight, kidney disease, bone density problems, and other medications that might affect bone healing.

The main thing they measured was whether bones healed properly or developed nonunion, which means the broken pieces didn’t fuse back together correctly.

This research approach is important because it looks at real-world patient data rather than just laboratory studies. By matching patients carefully, researchers could focus on the effect of PPIs specifically, rather than other factors that might explain differences in healing. This type of study helps doctors understand whether medications they prescribe every day might have unexpected effects on bone healing.

This study has several strengths: it included a very large number of patients (over 410,000), used data from multiple hospitals, and carefully controlled for other factors that could affect bone healing. However, because it looked at past medical records rather than following patients forward in time, researchers can’t be completely certain about cause and effect. The study was also limited to patients who had surgery—results might be different for people with less severe fractures treated without surgery.

What the Results Show

The study found that PPI use significantly increased the risk of bone healing problems in two specific locations. For lower leg and ankle fractures (tibia/fibula), patients taking PPIs had a 4.44% rate of healing problems compared to 2.21% in patients not taking PPIs—meaning PPI users were about twice as likely to have problems. For forearm fractures (radius/ulna), the rates were 3.36% versus 1.88%, also showing about double the risk.

The most striking finding was in younger patients (ages 18-44) with lower leg fractures. These patients taking PPIs had an 11-fold increased risk of healing problems compared to similar young patients not taking PPIs. This suggests that younger people might be more vulnerable to the bone-healing effects of these medications.

For upper arm (humerus) and thighbone (femur) fractures, the rates were higher in PPI users, but the differences were not statistically significant, meaning they could have happened by chance. However, the trend still suggested a possible effect worth monitoring.

The research revealed that the effect of PPIs on bone healing varies depending on where the fracture is located and how old the patient is. Younger patients consistently showed greater vulnerability to PPI-related healing problems than older patients. This age-related pattern was particularly pronounced in lower leg fractures, where young adults had dramatically higher risk. The findings suggest that PPIs may interfere with the biological processes that help bones heal, and this interference may be more pronounced in younger, more active patients.

Previous research has suggested that PPIs might affect bone health by reducing calcium absorption and interfering with bone metabolism. This study is one of the first to specifically examine whether this translates to real problems with fracture healing after surgery. The findings align with earlier concerns about PPIs and bone health but provide new evidence that the effect is significant enough to matter clinically in fracture patients.

This study looked backward at medical records rather than following patients forward, so we can’t be completely certain PPIs caused the healing problems—other unmeasured factors could be involved. The study also couldn’t account for how long patients took PPIs or at what doses. Additionally, the study only included patients who had surgery; results might differ for people with milder fractures. Finally, the reasons why PPIs might affect bone healing aren’t fully explained by this research—it shows an association but not the exact mechanism.

The Bottom Line

If you take proton pump inhibitors and need surgery for a broken bone, discuss this research with your orthopedic surgeon and gastroenterologist. They may consider: (1) whether your PPI is truly necessary during the healing period, (2) whether an alternative heartburn medication might work for you, or (3) whether additional bone-supporting measures (like vitamin D and calcium) should be added. Do not stop taking your PPI without medical guidance, as these medications are important for managing serious acid reflux. The evidence suggests caution and discussion, not avoidance. Confidence level: Moderate for lower leg and forearm fractures; Lower for other fracture types.

This research is most relevant for: (1) younger adults (18-44) who take PPIs and have lower leg or forearm fractures, (2) anyone taking PPIs who is about to have bone surgery, and (3) doctors who prescribe both PPIs and treat fractures. People taking PPIs for legitimate medical reasons should not be alarmed but should be informed. Those taking PPIs without a clear medical need might discuss with their doctor whether they still need them.

Bone healing typically takes 3-6 months for most fractures, though complete remodeling can take a year or more. If PPI use affects healing, problems usually become apparent within the first 3-4 months after surgery. If you’re taking PPIs and having bone surgery, discuss the healing timeline with your surgeon and plan follow-up imaging to monitor progress.

Want to Apply This Research?

  • If you’re recovering from bone surgery while taking PPIs, track: (1) pain levels daily on a 0-10 scale, (2) swelling/inflammation at the fracture site, (3) ability to bear weight or use the injured limb (with medical clearance), and (4) any signs of delayed healing noted by your doctor at follow-up appointments
  • Work with your healthcare team to: (1) document your current PPI use and dosage, (2) schedule a discussion with your doctor about alternatives before bone surgery if possible, (3) ensure adequate calcium and vitamin D intake during healing, and (4) attend all follow-up appointments to monitor healing progress
  • Set reminders for follow-up imaging appointments (typically at 6 weeks, 12 weeks, and 6 months post-surgery). Use the app to track healing milestones your doctor identifies and flag any concerns about slower-than-expected progress. Share this tracking data with your surgical team to help them monitor your individual healing trajectory.

This research suggests an association between proton pump inhibitors and slower bone healing after surgery, particularly for lower leg and forearm fractures. However, this does not mean you should stop taking your PPI medication without consulting your doctor—these medications are important for treating serious acid reflux and other conditions. If you take PPIs and are facing bone surgery, discuss this research with both your surgeon and the doctor who prescribed your PPI. They can help you weigh the benefits and risks specific to your situation. This information is educational and should not replace professional medical advice.