Abstract
BackgroundPatients with peptic ulcer disease (PUD) and gastroesophageal reflux disease (GERD) are more likely to receive long-term therapy with proton pump inhibitors (PPIs). This study aimed to investigate the risk of osteoporotic fractures in PPI users compared to histamine-2 receptor antagonist (H2RA) users and the association between fractures and the duration and regular use of PPI.MethodsA population-based, nationwide nested case-control study from January 2006 to December 2015 was performed using Korean National Health Insurance Service claims data. We included patients ≥50 years of age, without previous fractures, newly prescribed with PPI or H2RA, and diagnosed with PUD or GERD from 2006 to 2015. Patients with osteoporotic fracture (n = 59,240) were matched with the non-fracture control group (n = 296,200) at a 1:5 ratio based on sex, age, cohort entry date, follow-up duration, and bisphosphonate use. The osteoporotic fractures were defined using the diagnostic codes of claims data (M80, M81, M82, M484, M485, S220, S221, S320, S327, S422, S423, S525, S526, S72).ResultsThe higher the cumulative use of PPIs, the higher the osteoporotic fracture risk (P for trend < 0.001). The risk of osteoporotic fracture in the patients whose cumulative use of PPI was more than 1 year was higher than that of others (OR: 1.42, 95% CI: 1.32–1.52). Patients who regularly used PPI in the recent 1 year had a higher risk of osteoporotic fracture than exclusive H2RA users (OR: 1.37, 95% CI: 1.26–1.50).ConclusionsThe risk of osteoporotic fracture increased with the duration of PPI use, especially when PPI was used for ≥1 year and regularly in the recent 1 year.
Highlights
Patients with peptic ulcer disease (PUD) and gastroesophageal reflux disease (GERD) are more likely to receive long-term therapy with proton pump inhibitors (PPIs)
The risk of osteoporotic fracture in the patients whose cumulative use of PPI was more than 1 year was higher than that of others (OR: 1.42, 95% Confidence interval (CI): 1.32–1.52)
Patients who regularly used PPI in the recent 1 year had a higher risk of osteoporotic fracture than exclusive histamine-2 receptor antagonist (H2RA) users (OR: 1.37, 95% CI: 1.26–1.50)
Summary
Patients with peptic ulcer disease (PUD) and gastroesophageal reflux disease (GERD) are more likely to receive long-term therapy with proton pump inhibitors (PPIs). Proton pump inhibitors (PPIs), which are used for the treatment of GERD and PUD, are among the most frequently prescribed drugs for long-term use worldwide [1, 2]. Osteoporotic fractures are a major health problem worldwide and are expected to further increase in incidence with increases in life expectancy [9, 10]. Osteoporotic fractures are a major cause of increased mortality [11], increased number of hospitalizations [12, 13], high health-care costs, and reduced quality of life [14]. As PPIs are effective and widely used drugs, it is necessary to investigate the duration and patterns of their use, as well as what extent of PPI use is associated with osteoporotic fractures
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