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Study of the association between hip fracture and acid-suppressive drug use in a UK primary care setting.

Abstract

OBJECTIVES

We aimed to clarify the nature of the association between hip fracture risk and use of proton pump inhibitors (PPIs) or histamine2 -receptor antagonists (H2 RAs).

METHODS

We identified patients 40-89 years of age with a recorded hip fracture diagnosis in 2000-2008 using The Health Improvement Network, a UK primary care research database. Computerized records were reviewed and questionnaires sent to primary care physicians to validate hip fracture cases. A cohort study with a nested case-control analysis was performed to estimate the association between the use of acid-suppressive drugs and hip fracture.

RESULTS

Overall incidence of hip fracture per 1000 person-years was 1.31 (95% confidence interval [CI] 1.28-1.33). There was a modest increased risk of hip fracture after adjustment for potential confounders (odds ratios [OR] during current use of PPIs and H2 RAs: 1.09 [95% CI 1.01-1.17] and 1.04 [95% CI 0.90-1.19], respectively). Relative to nonuse, an increased risk of fracture was observed with medium and high doses of PPIs (OR 1.11 [95% CI 1.01-1.22] and OR 1.31 [95% CI 1.06-1.61], respectively) and high doses of H2 RAs (OR 2.77, 95% CI 1.21-6.37). No duration response was observed (ORs for current PPI use less than 1 month and 5 years or longer: 1.16 [95% CI 0.94-1.43] and 1.02 [95% CI 0.87-1.20], respectively).

CONCLUSIONS

Patients treated with PPIs showed a modest increased risk of hip fracture after adjustment for potential cofounders. Any remaining association between PPI use and hip fracture risk may be attributable to residual confounding.

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  • Authors+Show Affiliations

    ,

    Spanish Centre for Pharmacoepidemiologic Research (CEIFE), Madrid, Spain.

    , ,

    Source

    Pharmacotherapy 34:6 2014 Jun pg 570-81

    MeSH

    Adult
    Aged
    Aged, 80 and over
    Case-Control Studies
    Cohort Studies
    Female
    Hip Fractures
    Histamine H2 Antagonists
    Humans
    Incidence
    Male
    Middle Aged
    Primary Health Care
    Proton Pump Inhibitors
    Retrospective Studies
    Risk
    Surveys and Questionnaires
    United Kingdom

    Pub Type(s)

    Journal Article
    Research Support, Non-U.S. Gov't

    Language

    eng

    PubMed ID

    24634193

    Citation

    Cea Soriano, Lucia, et al. "Study of the Association Between Hip Fracture and Acid-suppressive Drug Use in a UK Primary Care Setting." Pharmacotherapy, vol. 34, no. 6, 2014, pp. 570-81.
    Cea Soriano L, Ruigómez A, Johansson S, et al. Study of the association between hip fracture and acid-suppressive drug use in a UK primary care setting. Pharmacotherapy. 2014;34(6):570-81.
    Cea Soriano, L., Ruigómez, A., Johansson, S., & García Rodríguez, L. A. (2014). Study of the association between hip fracture and acid-suppressive drug use in a UK primary care setting. Pharmacotherapy, 34(6), pp. 570-81. doi:10.1002/phar.1410.
    Cea Soriano L, et al. Study of the Association Between Hip Fracture and Acid-suppressive Drug Use in a UK Primary Care Setting. Pharmacotherapy. 2014;34(6):570-81. PubMed PMID: 24634193.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Study of the association between hip fracture and acid-suppressive drug use in a UK primary care setting. AU - Cea Soriano,Lucia, AU - Ruigómez,Ana, AU - Johansson,Saga, AU - García Rodríguez,Luis A, Y1 - 2014/03/13/ PY - 2014/3/18/entrez PY - 2014/3/19/pubmed PY - 2015/2/11/medline KW - H2RA KW - acid-suppressive drugs KW - fractures KW - proton pump inhibitor SP - 570 EP - 81 JF - Pharmacotherapy JO - Pharmacotherapy VL - 34 IS - 6 N2 - OBJECTIVES: We aimed to clarify the nature of the association between hip fracture risk and use of proton pump inhibitors (PPIs) or histamine2 -receptor antagonists (H2 RAs). METHODS: We identified patients 40-89 years of age with a recorded hip fracture diagnosis in 2000-2008 using The Health Improvement Network, a UK primary care research database. Computerized records were reviewed and questionnaires sent to primary care physicians to validate hip fracture cases. A cohort study with a nested case-control analysis was performed to estimate the association between the use of acid-suppressive drugs and hip fracture. RESULTS: Overall incidence of hip fracture per 1000 person-years was 1.31 (95% confidence interval [CI] 1.28-1.33). There was a modest increased risk of hip fracture after adjustment for potential confounders (odds ratios [OR] during current use of PPIs and H2 RAs: 1.09 [95% CI 1.01-1.17] and 1.04 [95% CI 0.90-1.19], respectively). Relative to nonuse, an increased risk of fracture was observed with medium and high doses of PPIs (OR 1.11 [95% CI 1.01-1.22] and OR 1.31 [95% CI 1.06-1.61], respectively) and high doses of H2 RAs (OR 2.77, 95% CI 1.21-6.37). No duration response was observed (ORs for current PPI use less than 1 month and 5 years or longer: 1.16 [95% CI 0.94-1.43] and 1.02 [95% CI 0.87-1.20], respectively). CONCLUSIONS: Patients treated with PPIs showed a modest increased risk of hip fracture after adjustment for potential cofounders. Any remaining association between PPI use and hip fracture risk may be attributable to residual confounding. SN - 1875-9114 UR - https://www.unboundmedicine.com/medline/citation/24634193/Study_of_the_association_between_hip_fracture_and_acid_suppressive_drug_use_in_a_UK_primary_care_setting_ L2 - https://doi.org/10.1002/phar.1410 DB - PRIME DP - Unbound Medicine ER -