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Higher Dose but Not Low Dose Proton Pump Inhibitors Are Associated With Increased Risk of Subsequent Hip Fractures After First Hip Fracture: A Nationwide Observational Cohort Study

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Higher Dose but Not Low Dose Proton Pump Inhibitors Are Associated With Increased Risk of Subsequent Hip Fractures After First Hip Fracture: A Nationwide Observational Cohort Study

Wolfgang Brozek et al. Bone Rep.

Abstract

Aim: To examine the association of proton pump inhibitor (PPI) use with subsequent hip fracture incidence in hip fracture patients, accounting for gender, age, PPI doses, PPI initiation before or after first fracture, and year from first fracture in which the first subsequent fracture occurred.

Methods: Data from 31,668 Austrian patients ≥50 years with the first hip fracture between July 2008 and December 2010 were analyzed retrospectively. After exclusion of patients on anti-osteoporotic medication, incidence of subsequent hip fractures was compared between users and non-users of PPIs using regression models.

Results: In general, use of PPIs among hip fracture patients was associated with increased risk for subsequent hip fracture (OR 1.58, 95%-CI 1.25-2.00), in particular in men, in the age group of 70-84 years, and when PPIs were initiated before the first fracture. Low PPI doses of ≤90 cumulative DDDs and ≤0.25 DDDs/day, however, were not linked to elevated subsequent fracture risk, especially among female patients. Subsequent hip fracture incidence was elevated within the first year after first fracture in female and male PPI users (OR 1.75, 95%-CI 1.28-2.38) and dropped in women but not in men in the second year.

Conclusions: Low-dose PPI use is not associated with increased risk of subsequent hip fractures, especially in women. Patients thus get most benefit of short-term PPI use after a hip fracture that has previously been linked to lowered mortality if low doses are not exceeded. Varying risk profiles for the time of subsequent hip fracture could have implications for risk group-specific follow-up care.

Keywords: Dosage; Hip fracture; Osteoporosis; Proton pump inhibitors; Subsequent fracture.

Figures

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Fig. 1
Study flow chart.

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References

    1. Abrahamsen B., Eiken P., Eastell R. Proton pump inhibitor use and the antifracture efficacy of alendronate. Arch Intern Med. 2011;171:998–1004. - PubMed
    1. Barbieri M., Rizzo M.R., Manzella D., Paolisso G. Age-related insulin resistance: is it an obligatory finding? The lesson from healthy centenarians. Diabetes Metab Res Rev. 2001;17:19–26. - PubMed
    1. Brozek W., Reichardt B., Kimberger O., Zwerina J., Dimai H.P., Kritsch D., Klaushofer K., Zwettler E. Mortality after hip fracture in Austria 2008–2011. Calcif Tissue Int. 2014;95:257–266. - PubMed
    1. Brozek W., Reichardt B., Zwerina J., Dimai H.P., Klaushofer K., Zwettler E. Use of proton pump inhibitors and mortality after hip fracture in a nationwide study. Osteoporos Int. 2017;28:1587–1595. - PubMed
    1. Cea Soriano L., Ruigómez A., Johansson S., García Rodríguez L.A. Study of the association between hip fracture and acid-suppressive drug use in a UK primary care setting. Pharmacotherapy. 2014;34:570–581. - PubMed

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