Proton Pump Inhibitors Are Associated With Increased Risk of Site-Specific Nonunion After Open Reduction Internal...

Area of Science:

• Orthopedics
• Pharmacology
• Epidemiology

Background:

• Proton pump inhibitors (PPIs) are widely used medications.
• Potential adverse effects of PPIs on bone health and fracture healing are a growing concern.
• Understanding the specific risks associated with PPI use in fracture patients is crucial for clinical practice.

Purpose of the Study:

• To investigate the association between proton pump inhibitor (PPI) use and the risk of fracture nonunion.
• To analyze this association across different anatomical fracture locations (humerus, radius/ulna, femur, tibia/fibula).
• To examine the influence of patient age groups on PPI-related nonunion risk.

Main Methods:

• Retrospective cohort study design.
• Utilized a multicenter database (TriNetX) with propensity score matching for confounding variable control.
• Included patients with operative fixation of long bone fractures (OTA/AO types 11-13, 21-23, 31-33, 41-43) from 2015-2023.

Main Results:

• Analyzed 410,433 patients, comparing PPI users and non-users.
• PPI use significantly increased nonunion risk in tibia/fibula (HR: 2.08) and radius/ulna fractures (HR: 1.85).
• Younger patients (18-44 years) with tibia/fibula fractures showed the highest vulnerability (HR: 10.87).

Conclusions:

• Proton pump inhibitor (PPI) use is associated with an increased risk of fracture nonunion.
• This association is particularly evident in tibia/fibula and radius/ulna fractures.
• Younger patient demographics appear more susceptible to PPI-associated nonunion, highlighting a need for further investigation.