Proton pump inhibitors associated with hip fracture in patients on hemodialysis

Use of proton pump inhibitors may increase risk of hip fracture in patients with ESKD on hemodialysis, according to a recently published study.

“Using a large nationwide registry of United States patients with ESKD requiring hemodialysis, we found that almost three quarters of patients who had a hip fracture had used a [proton pump inhibitor] PPI in the 3 years preceding their event, with close to 15% having filled PPI prescriptions representing supplies in excess of 80% of the days during that time interval,” Chandan Vangala, MD, of the section of nephrology at Baylor College of Medicine in Houston, and colleagues wrote. “When compared with controls frequency matched on the index date, we found a significant association between case status and prior PPI use.”

Researchers conducted a retrospective, case-controlled study using the U.S. Renal Data System to identify all hip fracture events that were recorded between 2009 and 2014 in patients dependent on hemodialysis (4,551 cases; median age, 72 years; 59% were women). Eligible cases were then matched on index date with ten controls (n = 45,510; median age, 62 years; 52% were women).

To determine proton pump inhibitor and histamine-2 receptor antagonist use, researchers examined Medicare Part D prescription claims, representing filled prescriptions. Use was defined as the presence of at least one prescription claim in the 3 years before the index date and was categorized as low, moderate or high.

Researchers used unadjusted and multivariable-adjusted, conditional logistic regression models to estimate independent associations between hip fracture case status and previous proton pump inhibitor and histamine-2 receptor antagonist use.

Researchers found use of proton pump inhibitor was associated with higher risk of hip fracture (adjusted OR = 1.19). This association was further seen in the subgroups of low (adjusted OR = 1.16), moderate (adjusted OR = 1.21) and high (adjusted OR = 1.19).

No associations were found between hip fracture and histamine-2 receptor antagonist use.

“Prevalent long-term PPI use in patients dependent on hemodialysis warrants heightened vigilance over the continued necessity of these medications,” the researchers wrote.

“The lack of an association with prior histamine-2 receptor antagonist use and the study patients’ hemodialysis-dependent status may suggest a more direct influence of PPIs on bone quality, as opposed to cation and nutrient stores. Thus, we recommend interval assessment of continued PPI use in patients dependent on hemodialysis who already experience substantial medical burden.” – by Melissa J. Webb

Disclosure s : Vangala reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.