The effect of dose and type of proton pump inhibitor use on risk of fractures and osteoporosis treatment in older Australian women: A prospective cohort study

van der Hoorn, Mariëlle M. C., Tett, Susan E., de Vries, Oscar J., Dobson, Annette J. and Peeters, G. M. E. E. G. (Geeske) (2015) The effect of dose and type of proton pump inhibitor use on risk of fractures and osteoporosis treatment in older Australian women: A prospective cohort study. Bone, 81 675-682. doi:10.1016/j.bone.2015.08.024


Author van der Hoorn, Mariëlle M. C.
Tett, Susan E.
de Vries, Oscar J.
Dobson, Annette J.
Peeters, G. M. E. E. G. (Geeske)
Title The effect of dose and type of proton pump inhibitor use on risk of fractures and osteoporosis treatment in older Australian women: A prospective cohort study
Journal name Bone   Check publisher's open access policy
ISSN 8756-3282
1873-2763
Publication date 2015-12-01
Sub-type Article (original research)
DOI 10.1016/j.bone.2015.08.024
Open Access Status Not Open Access
Volume 81
Start page 675
End page 682
Total pages 8
Place of publication Philadelphia, PA, United States
Publisher Elsevier
Collection year 2016
Language eng
Formatted abstract
Objectives: Proton pump inhibitors (PPIs) are among the most prescribed medications worldwide, however, there is growing concern regarding potential negative effects on bone health. The aim was to examine the effect of dose and type of PPI use on subsequent use of osteoporosis medication and fractures in older Australian women.

Methods: Data were included from 4432 participants (born 1921–26) in the 2002 survey of the Australian Longitudinal Study on Women’s Health. Medication data were from the national pharmaceutical administrative database (2003–2012, inclusive). Fractures were sourced from linked hospital datasets available for four major States of Australia. Competing risk regression models used PPI exposure as a time-dependent covariate and either time to first osteoporosis medication prescription or fracture as the outcome, with death as a competing risk.

Results: Of the 2328 PPI users and 2104 PPI non-users, 827 (36%) and 550 (26%) became users of osteoporosis medication, respectively. PPI use was associated with an increased risk of subsequent use of osteoporosis medication (adjusted sub-hazard ratio [SHR] = 1.28; 95% confidence interval [CI] = 1.13-1.44) and subsequent fracture (SHR = 1.29, CI = 1.08-1.55). Analysis with PPI categorized according to defined daily dose (DDD), showed some evidence for a dose–response effect (osteoporosis medication: < 400 DDD: SHR = 1.23, CI = 1.06-1.42 and ≥ 400 DDD: SHR = 1.39, CI = 1.17-1.65, compared with non-users; SHRs were in the same range for fractures). Esomeprazole was the most common PPI prescribed (22.9%). Analysis by type of PPI use showed an increased subsequent risk for: (1) use of osteoporosis medication for rabeprazole (SHR = 1.51, CI = 1.08-2.10) and esomeprazole (SHR = 1.48, CI = 1.17-1.88); and (2) fractures for rabeprazole (SHR = 2.06, CI = 1.37-3.10). Users of multiple types of PPI also had increased risks for use of osteoporosis medication and fractures.

Conclusion: An appropriate benefit/risk assessment should be made when prescribing PPIs, especially for esomeprazole and rabeprazole, as osteoporosis and fracture risks were increased in this cohort of elderly females subsequent to PPI prescription.
Keyword Esomeprazole
Fractures
Omeprazole
Osteoporosis medication
Proton pump inhibitors
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

 
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