- Proton-pump inhibitor (PPI) use is tied to increased risk for bone and hip fracture among patients undergoing hemodialysis.
- Risk is independent of competing mortality risk and potential confounders, including clinical factors and concomitant therapies.
Why this matters
- PPIs are among the most commonly potentially inappropriate medications listed in BEERS criteria from the American Geriatrics Society.
- The proportion of patients using PPIs is markedly higher among hemodialysis patients than the general population, where they have been previously linked to fracture.
- Data for 27,097 hemodialysis patients from the international prospective DOPPS study; 13,283 (49.0%) were receiving PPIs.
- Median follow-up: 19 (interquartile range, 10-28) months.
- Funding: None.
- 1592 patients experienced bone fractures; 528 had hip fractures.
- Incidence (per 100 person-years) was 3.8 and 1.2 for bone and hip fractures, respectively.
- 6249 patients died; mortality was higher in PPI users vs nonusers (25.8% vs 20.4%; P<.001>
- After accounting for competing mortality risk, PPI use was linked to:
- 22% higher incidence of bone fracture (subdistribution HR [SHR]=1.22; P<.001>
- 35% higher incidence of hip fracture (SHR=1.35; P=.001).
- 47% higher risk for bone fracture (HR, 1.47; P<.001>
- 85% higher risk for hip fracture (HR, 1.85; P<.001>
- Observational design.