Premium
Proton pump inhibitor use and the risk of fractures among an older adult cohort
Author(s) -
Harding Barbara N.,
Weiss Noel S.,
Walker Rod L.,
Larson Eric B.,
Dublin Sascha
Publication year - 2018
Publication title -
pharmacoepidemiology and drug safety
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.023
H-Index - 96
eISSN - 1099-1557
pISSN - 1053-8569
DOI - 10.1002/pds.4406
Subject(s) - medicine , hazard ratio , pharmacoepidemiology , retrospective cohort study , proportional hazards model , confounding , proton pump inhibitor , cohort , cohort study , medical record , emergency medicine , confidence interval , medical prescription , pharmacology
Purpose The purpose of the study is to determine if the use of a proton pump inhibitor (PPI) is associated with an increased fracture risk, as some prior studies have suggested. Methods This retrospective cohort study included data on 4438 participants aged 65 and older who had no fracture in the year prior to baseline and had ≥5 years of enrollment history in Kaiser Permanente Washington, an integrated healthcare delivery system in Seattle, WA, during 1994 to 2014. Time‐varying cumulative exposure to PPIs was determined from automated pharmacy data by summing standard daily doses (SDDs) across fills, and patients were categorized as no use (reference group, ≤30 SDD), light use (31‐540 SDD), moderate use (541‐1080 SDD), and heavy use (≥1081 SDD). Incident fractures were assessed using International Classification of Diseases, Ninth Revision codes from electronic medical records. Potential confounders, chosen a priori, were assessed at baseline and at each 2‐year follow‐up visit. Fracture risk was analyzed using a Cox proportional hazards model. Results Over a mean follow‐up of 6.1 years, 802 (18.1%) participants experienced a fracture. No overall association was found between PPI use and fracture risk. Adjusted hazard ratios comparing users to the referent category were 1.08 (95% CI 0.83‐1.40) for light users, 1.31 (95% CI 0.86‐1.95) for moderate users, and 0.95 (95% CI 0.68‐1.34) for heavy users. Among patients with SSD > 30, no appreciable increase in fracture risk was present in persons with recent versus distant use (adjusted hazard ratio of 1.14 [95% CI 0.91‐1.42]). Conclusions No association was observed between PPI use and fracture risk among older adults.