Abstract
Purpose: Current literature on the risk of fractures in patients on proton pump inhibitors (PPI) has yielded mixed results. This study evaluated the association between PPI use and incidence of osteoporotic fractures in male patients. Methods: Retrospective chart review was conducted at the Phoenix Veterans Affairs Health Care System from January 1, 1995 to July 23, 2012 for this case control study. Inclusion criteria included all male patients who were diagnosed as having a hip, wrist or spine fracture. A 3:1 sample of controls (patients without fractures) was drawn from the same period. Demographic information including age, body mass index (BMI), ethnicity, tobacco, and alcohol use were collected for all patients. Thiazides, bisphosphonates and steroid use data were also collected for patients with a fracture and PPI use. Results: A total of 246 male patients, mean age 65.3 years, suffered a hip (20%), wrist (30%) or spine (50%) fracture during the study period. Of these, 33 (13.4%) used chronic PPI's prior to the fracture. Among patients without fractures, 107 (14.1%) were using PPI's. Increasing BMI and PPI use are protective against hip fracture, (p<0.001). PPI's are protective against spine fracture and more so with increasing age, (p<0.05). For males not on PPI, incidence of spine fracture significantly increases with age. For those not taking bisphosphonate, taking PPIs reduces the risk of wrist fracture (p<0.001). Alcohol use was higher in the fracture group (74% vs 59%), and smoking rates were similar in both groups: 70% and 66% with and without fractures, respectively. Average BMI was 26 in both groups. Multivariable logistic regression modeling revealed a significant association of fracture with age and BMI, which depend on the fracture location. Conclusion: This study found no significant evidence of an association between chronic PPI use and hip, wrist or spine fracture in men over 55 years old. PPI use appears to be protective.
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