PPIs tied to excess fracture risk in hemodialysis patients

  • Fusaro M & al.
  • J Bone Miner Res
  • 31.07.2019

  • von Yael Waknine
  • Clinical Essentials
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Takeaway

  • 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.

Study design

  • 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.

Key results

  • 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).
  • Findings supported in multivariate analysis matching patients by prescription time:
    • 47% higher risk for bone fracture (HR, 1.47; P<.001>
    • 85% higher risk for hip fracture (HR, 1.85; P<.001>

Limitations

  • Observational design.