Use of proton pump inhibitors and mortality after hip fracture in a nationwide study

Abstract

PPI use during and after hospital stay due to hip fracture is associated with a considerable decrease in mortality. These findings could have implications for hip fracture treatment.

Higher dose but not low dose proton pump inhibitors are associated with increased risk of subsequent hip fractures after first hip fracture: A nationwide observational cohort study

“…Notably, this would be independent of pre- or post-index fracture initiation of PPIs and true of all age groups where the increase in ORs is driven by males. We have previously shown that PPI use in hip fracture patients, in particular during hospital stay and after discharge, significantly decreases short-term mortality up to 90 days post-hip fracture ( Brozek et al, 2017 ). It is conceivable that targeted short-term administration of PPIs after a hip fracture can be achieved without exceeding low doses, thus minimizing subsequent hip fracture risk especially in women, besides exerting a beneficial effect on patient survival.…”

“…≤90 DDDs and ≤0.25 DDDs/day among female patients in particular. Since we have recently demonstrated that PPI use entails reduction of short-term (90-day) mortality in hip fracture patients ( Brozek et al, 2017 ), targeted short-term use of PPIs that does not exceed low doses, besides exerting beneficial effects on survival, is safe with respect to subsequent hip fracture risk, especially in women. However, it must be borne in mind that our results portend selection bias and confounding as the main sources of heterogeneity.…”

“…Lee et al, 2013 ). Baseline characteristics of the study population ( Brozek et al, 2014 ) and of PPI prescription data ( Brozek et al, 2017 ) were described previously. The local Ethics Committee approved the study which was performed in agreement with the Declaration of Helsinki.…”

“…All patients in the control group therefore survived at least the amount of time from index fracture until subsequent fractures could occur and until patients who began PPI treatment after index fracture had already started medication. Splitting up patients into PPI beginners before vs. after index fracture was motivated by previously obtained disparate results on mortality in these patient groups ( Brozek et al, 2017 ). PPI users were compared with the control cohort using multivariate regression adjusting for gender, age at index fracture, and follow-up time.…”

Letter: proton pump inhibitor use and risk of fracture

“…Last, among patients with hip fracture, PPI use can improve recovery and decrease mortality. 10 Although there was no association between long-term use of PPIs and increased risk of hip fracture in Torvinen-Kiiskinen's study, were there any differences in the prognosis of hip fracture among patients with current PPI use as opposed to past use, or short-term vs long-term use?…”