PPI Use Associated with Hip-Fracture Risk in Postmenopausal Women

Summary and Comment |
March 23, 2012

PPI Use Associated with Hip-Fracture Risk in Postmenopausal Women

  1. David J. Bjorkman, MD, MSPH (HSA), SM (Epid.)

Data from a large, prospective cohort study showed risk to be highest in smokers and in women with lengthy PPI use.

  1. David J. Bjorkman, MD, MSPH (HSA), SM (Epid.)

Several studies have suggested an association between proton-pump inhibitor (PPI) use and hip fracture. To explore this issue, investigators used data on PPI use from 79,899 postmenopausal women enrolled in the Nurses' Health Study — a large, prospective cohort study.

During 565,786 person-years of follow-up, 893 hip fractures occurred. The incidence of hip fracture per 1000 person-years was 2.0 in regular PPI users versus 1.5 in nonusers (age-adjusted hazard ratio, 1.35; 95% confidence interval, 1.13–1.62). The risk remained similarly elevated after adjustment for known risk factors and rose with duration of PPI use; it did not vary by indication for PPI prescription. Discontinuation of PPIs for >2 years returned the risk to that of nonusers. Regular use of histamine-2–receptor antagonists showed a more modest association with hip fracture (adjusted hazard ratio, 1.23; 95% CI, 1.02–1.50). Using stratified analysis, the investigators showed that the increased risk for fracture with PPI use was seen in current and previous smokers, but not in never-smokers.

The authors also performed a meta-analysis of 10 previous studies exploring the relationship between PPI use and hip fracture. The pooled odds ratio of hip fracture with chronic PPI use was 1.28 (95% CI, 1.19–1.37), with moderate across-study heterogeneity.

Comment

Although previous studies have demonstrated an association between PPI use and hip fracture, data from the Nurses' Health Study suggest that this effect might occur predominantly in smokers. This information might shed light on a potential mechanism for the association.

Citation(s):

Reader Comments (1)

Thomas R Simpson

It seems like men are discriminated against in more & more studies. Women tend to be studied since there are so many nurses/aides available to study vs. the number of men. We need a study like this (and others) done on men to see if there are any sex differences.

Competing interests: None declared

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