AIMS: Previous studies reported proton pump inhibitor (PPI) use may increase the risk of fracture; however, the findings may be susceptible to indication bias because peptic ulcer disease (PUD), 1 major indication for PPIs, may affect skeletal health. Determining whether PUD would increase hip fracture risk may help identify high-risk populations and explore risk factors.
METHODS: We conducted a cohort study using data from The Health Improvement Network (THIN) in the United Kingdom. THIN contains patient information such as disease diagnosis and medicine prescriptions. Up to 5 non-PUD individuals (n = 138 265) were matched to each case of incident PUD (n = 27 653) by age, sex, and body mass index. We examined the association between PUD and hip fracture by a multivariable Cox proportional hazard model. We repeated the same analysis among individuals with incident PUD and gastroesophageal reflux disease (GERD) (n = 27 160), another disease with similar indication for PPIs, as a positive control exposure.
RESULTS: Over a mean of 5.6 years of follow-up, hip fracture occurred in 589 individuals with PUD and 2015 individuals without PUD (3.8 vs 2.6/1000 person-years), with a multivariable-adjusted hazard ratio (HR) being 1.44 (95% confidence interval [CI], 1.31-1.58). The association persisted among subgroups stratified by sex and age. In positive control exposure analysis, the hip fracture risk was also higher in PUD than GERD (3.8 vs 2.4/1000 person-years; multivariable-adjusted HR = 1.65; 95% CI, 1.45-1.7).
CONCLUSIONS: This general population-based cohort study suggests, after controlling for acid-lowering medication and other potential risk factors, PUD is independently associated with an increased risk of hip fracture.
|投稿者||Li, Jiatian; Lu, Na; Lyu, Houchen; Lei, Guanghua; Zeng, Chao; Wei, Jie; Wang, Yilun; Xie, Dongxing|
|組織名||Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha,;410008, China.;Arthritis Research Canada, Richmond, V5Y3P2, Canada.;National Clinical Research Center for Orthopedics, Sports Medicine &;Rehabilitation, Beijing, 100853, China.;Department of Orthopedics, General Hospital of Chinese PLA, Beijing, 100853,;China.;Hunan Key Laboratory of Joint Degeneration and Injury, Changsha, 410008, China.;Hunan Engineering Research Center for Osteoarthritis, Changsha, 410008, China.;National Clinical Research Center for Geriatric Disorders, Xiangya Hospital,;Central South University, Changsha, 410008, China.;Health Management Center, Xiangya Hospital, Central South University, Changsha,|