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Use of proton pump inhibitors and risk of hip fracture in relation to dietary and lifestyle factors: a prospective cohort study.
BMJ 2012; 344:e372BMJ

Abstract

OBJECTIVE

To examine the association between chronic use of proton pump inhibitors (PPIs) and risk of hip fracture.

DESIGN

Prospective cohort study.

SETTING

Nurses' Health Study, which originally recruited from the 11 most populous states in the US.

PARTICIPANTS

79,899 postmenopausal women enrolled in the Nurses' Health Study who provided data on the use of PPIs and other risk factors biennially since 2000 and were followed up to 1 June 2008.

MAIN OUTCOME MEASURE

Incident hip fracture

RESULTS

During 565,786 person years of follow-up, we documented 893 incident hip fractures. The absolute risk of hip fracture among regular users of PPIs was 2.02 events per 1000 person years, compared with 1.51 events per 1000 person years among non-users. Compared with non-users, the risk of hip fracture among women who regularly used PPIs for at least two years was 35% higher (age adjusted hazard ratio 1.35 (95% confidence interval 1.13 to 1.62)), with longer use associated with increasing risk (P(trend)<0.01). Adjustment for risk factors, including body mass index, physical activity, and intake of calcium did not materially alter this association (hazard ratio 1.36 (1.13 to 1.63)). These associations were also not changed after accounting for reasons for PPI use. The relation between PPI use and fracture differed by smoking history (P(interaction)=0.03). Among current and former smokers, PPI use was associated with greater than 50% increase in risk of fracture, with a multivariate hazard ratio for fracture of 1.51 (1.20 to 1.91). In contrast, among women who never smoked there was no association (multivariate hazard ratio 1.06 (0.77 to 1.46)). In a meta-analysis of these results with 10 prior studies, the pooled odds ratio of hip fracture associated with PPI use was 1.30 (1.25 to 1.36).

CONCLUSION

Chronic use of PPIs is associated with increased risk of hip fracture, particularly among women with a history of smoking.

Authors+Show Affiliations

Gastroenterology Unit, Massachusetts General Hospital, Boston, MA 02114, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

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

Language

eng

PubMed ID

22294756

Citation

Khalili, Hamed, et al. "Use of Proton Pump Inhibitors and Risk of Hip Fracture in Relation to Dietary and Lifestyle Factors: a Prospective Cohort Study." BMJ (Clinical Research Ed.), vol. 344, 2012, pp. e372.
Khalili H, Huang ES, Jacobson BC, et al. Use of proton pump inhibitors and risk of hip fracture in relation to dietary and lifestyle factors: a prospective cohort study. BMJ. 2012;344:e372.
Khalili, H., Huang, E. S., Jacobson, B. C., Camargo, C. A., Feskanich, D., & Chan, A. T. (2012). Use of proton pump inhibitors and risk of hip fracture in relation to dietary and lifestyle factors: a prospective cohort study. BMJ (Clinical Research Ed.), 344, pp. e372. doi:10.1136/bmj.e372.
Khalili H, et al. Use of Proton Pump Inhibitors and Risk of Hip Fracture in Relation to Dietary and Lifestyle Factors: a Prospective Cohort Study. BMJ. 2012 Jan 30;344:e372. PubMed PMID: 22294756.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Use of proton pump inhibitors and risk of hip fracture in relation to dietary and lifestyle factors: a prospective cohort study. AU - Khalili,Hamed, AU - Huang,Edward S, AU - Jacobson,Brian C, AU - Camargo,Carlos A,Jr AU - Feskanich,Diane, AU - Chan,Andrew T, Y1 - 2012/01/30/ PY - 2012/2/2/entrez PY - 2012/2/2/pubmed PY - 2012/3/20/medline SP - e372 EP - e372 JF - BMJ (Clinical research ed.) JO - BMJ VL - 344 N2 - OBJECTIVE: To examine the association between chronic use of proton pump inhibitors (PPIs) and risk of hip fracture. DESIGN: Prospective cohort study. SETTING: Nurses' Health Study, which originally recruited from the 11 most populous states in the US. PARTICIPANTS: 79,899 postmenopausal women enrolled in the Nurses' Health Study who provided data on the use of PPIs and other risk factors biennially since 2000 and were followed up to 1 June 2008. MAIN OUTCOME MEASURE: Incident hip fracture RESULTS: During 565,786 person years of follow-up, we documented 893 incident hip fractures. The absolute risk of hip fracture among regular users of PPIs was 2.02 events per 1000 person years, compared with 1.51 events per 1000 person years among non-users. Compared with non-users, the risk of hip fracture among women who regularly used PPIs for at least two years was 35% higher (age adjusted hazard ratio 1.35 (95% confidence interval 1.13 to 1.62)), with longer use associated with increasing risk (P(trend)<0.01). Adjustment for risk factors, including body mass index, physical activity, and intake of calcium did not materially alter this association (hazard ratio 1.36 (1.13 to 1.63)). These associations were also not changed after accounting for reasons for PPI use. The relation between PPI use and fracture differed by smoking history (P(interaction)=0.03). Among current and former smokers, PPI use was associated with greater than 50% increase in risk of fracture, with a multivariate hazard ratio for fracture of 1.51 (1.20 to 1.91). In contrast, among women who never smoked there was no association (multivariate hazard ratio 1.06 (0.77 to 1.46)). In a meta-analysis of these results with 10 prior studies, the pooled odds ratio of hip fracture associated with PPI use was 1.30 (1.25 to 1.36). CONCLUSION: Chronic use of PPIs is associated with increased risk of hip fracture, particularly among women with a history of smoking. SN - 1756-1833 UR - https://www.unboundmedicine.com/medline/citation/22294756/Use_of_proton_pump_inhibitors_and_risk_of_hip_fracture_in_relation_to_dietary_and_lifestyle_factors:_a_prospective_cohort_study_ L2 - http://www.bmj.com/cgi/pmidlookup?view=long&amp;pmid=22294756 DB - PRIME DP - Unbound Medicine ER -