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Proton pump inhibitors and histamine-2 receptor antagonists are associated with hip fractures among at-risk patients.

Abstract

BACKGROUND & AIMS

Drugs that inhibit gastric acid might increase the risk of hip fracture. However, little long-term exposure data exist and no large studies have been conducted in the United States.

METHODS

We conducted a case-control study using data from an integrated health services organization. We evaluated 33,752 patients with incident diagnoses of hip/femur fractures (cases), 130,471 matched members without fractures (controls), prescription data for use of proton pump inhibitors (PPIs) or histamine-2 receptor antagonists (H2RAs) (up to 10 years' cumulative duration), and confounders.

RESULTS

Patients with hip fractures were more likely than controls to have previously received a > or =2-year supply of PPIs (odds ratio [OR], 1.30; 95% confidence interval [CI], 1.21-1.39) or H2RAs (OR, 1.18; 95% CI, 1.08-1.29). The risk was reduced after discontinuation of medication (OR of 1.30 [95% CI, 1.21-1.41] for current PPI users vs OR of 1.09 [95% CI, 0.64-1.85] for patients who received their last prescription 2-2.9 years ago). Higher dosages (but not increasing cumulative durations) were associated with increased risk (eg, > or =1.5 pills/day: OR, 1.41 [95% CI, 1.21-1.64]; <0.74 pills/day: OR, 1.12 [95% CI, 0.94-1.33]). Excess fracture risk for PPI use was only present among persons with at least one other fracture risk factor.

CONCLUSIONS

Use of drugs that inhibit gastric acid is associated with an increased risk of hip fracture; however, this association was only found among persons with at least one other risk factor for hip fracture. Acid inhibition might therefore be associated with fracture risk in persons already at risk for osteoporosis, although other confounding cannot be excluded.

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  • Authors+Show Affiliations

    ,

    Kaiser Permanente Division of Research, Oakland, California 94612, USA. douglas.corley@kp.org

    , ,

    Source

    Gastroenterology 139:1 2010 Jul pg 93-101

    MeSH

    Adolescent
    Adult
    Age Factors
    Aged
    Aged, 80 and over
    Case-Control Studies
    Dose-Response Relationship, Drug
    Female
    Gastric Acid
    Hip Fractures
    Histamine H2 Antagonists
    Humans
    Incidence
    Male
    Middle Aged
    Proton Pump Inhibitors
    Risk Factors

    Pub Type(s)

    Journal Article
    Research Support, N.I.H., Extramural
    Research Support, Non-U.S. Gov't

    Language

    eng

    PubMed ID

    20353792

    Citation

    Corley, Douglas A., et al. "Proton Pump Inhibitors and Histamine-2 Receptor Antagonists Are Associated With Hip Fractures Among At-risk Patients." Gastroenterology, vol. 139, no. 1, 2010, pp. 93-101.
    Corley DA, Kubo A, Zhao W, et al. Proton pump inhibitors and histamine-2 receptor antagonists are associated with hip fractures among at-risk patients. Gastroenterology. 2010;139(1):93-101.
    Corley, D. A., Kubo, A., Zhao, W., & Quesenberry, C. (2010). Proton pump inhibitors and histamine-2 receptor antagonists are associated with hip fractures among at-risk patients. Gastroenterology, 139(1), pp. 93-101. doi:10.1053/j.gastro.2010.03.055.
    Corley DA, et al. Proton Pump Inhibitors and Histamine-2 Receptor Antagonists Are Associated With Hip Fractures Among At-risk Patients. Gastroenterology. 2010;139(1):93-101. PubMed PMID: 20353792.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Proton pump inhibitors and histamine-2 receptor antagonists are associated with hip fractures among at-risk patients. AU - Corley,Douglas A, AU - Kubo,Ai, AU - Zhao,Wei, AU - Quesenberry,Charles, Y1 - 2010/03/27/ PY - 2009/08/13/received PY - 2010/03/15/revised PY - 2010/03/25/accepted PY - 2010/4/1/entrez PY - 2010/4/1/pubmed PY - 2010/8/5/medline SP - 93 EP - 101 JF - Gastroenterology JO - Gastroenterology VL - 139 IS - 1 N2 - BACKGROUND & AIMS: Drugs that inhibit gastric acid might increase the risk of hip fracture. However, little long-term exposure data exist and no large studies have been conducted in the United States. METHODS: We conducted a case-control study using data from an integrated health services organization. We evaluated 33,752 patients with incident diagnoses of hip/femur fractures (cases), 130,471 matched members without fractures (controls), prescription data for use of proton pump inhibitors (PPIs) or histamine-2 receptor antagonists (H2RAs) (up to 10 years' cumulative duration), and confounders. RESULTS: Patients with hip fractures were more likely than controls to have previously received a > or =2-year supply of PPIs (odds ratio [OR], 1.30; 95% confidence interval [CI], 1.21-1.39) or H2RAs (OR, 1.18; 95% CI, 1.08-1.29). The risk was reduced after discontinuation of medication (OR of 1.30 [95% CI, 1.21-1.41] for current PPI users vs OR of 1.09 [95% CI, 0.64-1.85] for patients who received their last prescription 2-2.9 years ago). Higher dosages (but not increasing cumulative durations) were associated with increased risk (eg, > or =1.5 pills/day: OR, 1.41 [95% CI, 1.21-1.64]; <0.74 pills/day: OR, 1.12 [95% CI, 0.94-1.33]). Excess fracture risk for PPI use was only present among persons with at least one other fracture risk factor. CONCLUSIONS: Use of drugs that inhibit gastric acid is associated with an increased risk of hip fracture; however, this association was only found among persons with at least one other risk factor for hip fracture. Acid inhibition might therefore be associated with fracture risk in persons already at risk for osteoporosis, although other confounding cannot be excluded. SN - 1528-0012 UR - https://www.unboundmedicine.com/medline/citation/20353792/Proton_pump_inhibitors_and_histamine_2_receptor_antagonists_are_associated_with_hip_fractures_among_at_risk_patients_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0016-5085(10)00488-9 DB - PRIME DP - Unbound Medicine ER -