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.

Authors:
Wolfgang Brozek
Wolfgang Brozek
Medical University of Vienna
Austria
Berthold Reichardt
Berthold Reichardt
Sickness Fund Burgenland
Jochen Zwerina
Jochen Zwerina
Ludwig Boltzmann Institute of Osteology at the Hanusch Hospital of WGKK and AUVA Trauma Centre Meidling
Germany
Hans Peter Dimai
Hans Peter Dimai
Medical University of Graz
Austria
Klaus Klaushofer
Klaus Klaushofer
Ludwig Boltzmann Institute of Osteology at the Hanusch Hospital of WGKK and AUVA Trauma Centre Meidling
Austria
Elisabeth Zwettler
Elisabeth Zwettler
Ludwig Boltzmann Institute of Osteology at the Hanusch Hospital of the Vienna Health Insurance Fund (WGKK) and Trauma Center Meidling of the Austrian Workers' Compensation Board (AUVA)
Austria

Bone Rep 2019 Jun 1;10:100204. Epub 2019 Apr 1.

Ludwig Boltzmann Institute of Osteology, Hanusch Hospital of the WGKK and AUVA Trauma Center, 1 Medical Department at Hanusch Hospital, Heinrich Collin Str. 30, 1140 Vienna, Austria.

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.

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Source
http://dx.doi.org/10.1016/j.bonr.2019.100204DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6451165PMC
June 2019
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