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Proton pump inhibitor use and bone fractures in patients with chronic kidney disease
Andreas Kommer1, Karel Kostev2, Eva Maria Schleicher1
1Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany.
Insights
Proton pump inhibitor (PPI) use increases fracture risk in chronic kidney disease (CKD) patients. Reducing PPI use in CKD patients without a clear indication may lower fracture incidence.
Area of Science:
- Nephrology
- Pharmacology
- Bone Metabolism
Background:
- Patients with chronic kidney disease (CKD) face a high risk of bone fractures, leading to significant morbidity and mortality.
- Previous studies suggested a link between proton pump inhibitor (PPI) use and fractures in the general population and hemodialysis patients, but data for CKD patients were lacking.
Purpose of the Study:
- To investigate the association between proton pump inhibitor (PPI) use and the risk of bone fractures in patients with chronic kidney disease (CKD).
Main Methods:
- A population-based, observational case-control study was conducted using the IQVIA Disease Analyzer database.
- Patients with CKD and fractures were matched 1:1 with controls without fractures using propensity score matching.
- Multivariable logistic regression analyses were performed to assess the association between PPI use and fractures, adjusting for confounding factors.
Main Results:
- The study included 6076 patients with fractures and 6076 matched controls without fractures.
- Proton pump inhibitor (PPI) use was significantly associated with an increased risk of fractures in CKD patients (OR 1.68; 95% CI 1.55-1.83).
- The strongest association was observed in patients under 60 years old with long-term PPI use (>2 years) or high cumulative PPI doses, with no difference noted between sexes.
Conclusions:
- Proton pump inhibitor (PPI) use is linked to an elevated risk of fractures in patients suffering from chronic kidney disease (CKD).
- Deprescribing proton pump inhibitors (PPIs) in CKD patients lacking a valid indication presents a potential modifiable strategy to mitigate fracture risk in this vulnerable population.
Background:
Patients with chronic kidney disease (CKD) are at high risk for bone fractures, which are associated with high morbidity and mortality. Proton pump inhibitors (PPI) have been linked to an increased risk for fractures in the general population as well as in patients with need for hemodialysis, but studies in patients with CKD are currently missing.
Methods:
We performed a population-based observational case-control study exploring a sample of patients with CKD derived from the IQVIATM Disease Analyzer database. Patients with and without fractures were matched using the 1:1 nearest neighbor propensity score matching method. To investigate the association between PPI use and fractures, multivariable logistic regression analyses were performed adjusting for confounding factors.
Results:
In total, 6076 patients with and 6076 patients without fractures were matched and subsequently available for analyses. In the total cohort, PPI use was associated with an increased risk for fractures [odds ratio (OR) 1.68; 95% confidence interval (95% CI) 1.55-1.83]. This association was noted for nearly all types of fractures. The strongest association between PPI use and fractures was found in patients below the age of 60 years with a PPI prescription for longer than 2 years (OR 6.85; 95% CI 1.85-25.38). The same was true when analyzing cumulative PPI doses. Here, patients below the age of 60 years with a cumulative PPI dose above 16 000 mg (highest quartile) had the highest risk for fractures (OR 4.62; 95% CI 1.87-11.44). There was no difference between men or women regarding the association between PPI use and fractures.
Conclusions:
This study provides evidence that PPI use is associated with fractures in patients with CKD. Deprescription of PPI in patients without an indication for treatment could be a modifiable risk factor to reduce fracture risk in this high-risk group.
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