Use of Acid-Suppression Medication and Risk of Hip Fracture

• Main Authors: Ya-Wen Huang, 黃雅雯
• Other Authors: Chun-Yuh Yang
• Format: Others
• Language: zh-TW
• Published: 2009
• Online Access: http://ndltd.ncl.edu.tw/handle/62762329863616279757

碩士 === 高雄醫學大學 === 公共衛生學研究所 === 97 === Background: Acid-suppression medications, such as histamine type 2 receptor antagonists (H2RAs) and proton pump inhibitors (PPIs), have become one of the most commonly prescribed classes of therapeutic agents. Among the various forms of low-trauma fractures, hip fracture leads to the most devastating consequences. PPIs may interfere with calcium absorption through induction of hypochlorhydria but they also may reduce bone resorption through inhibition of osteoclastic vacuolar proton pumps. Among previous studies, the association between acid-suppressive medication use and hip fracture is inconsistency. Objective: To investigate the association between acid-suppressive medication and risk of hip fracture. Material and methods: A case-control study was conducted using the National Health Insurance Research Database (NHIRD). The individuals were excluded from the study if they met at least one of the following criteria: (1) younger than 50 years at the index date; (2) had a documented fracture before the index date; (3) had a procedure of specific operations before the index date. Cases included all patients with an incident hip fracture between January 2005 and December 2006. For each case, one control without any fracture was matched of age (±3 year), gender, and index date (±3 day), and selected by random sampling from the background population. Results: We matched 1,241 pairs of incident hip fracture cases and controls. Controlling only for other medications (model I), the adjusted odds ratio (AOR) for hip fracture associated with PPI therapy was 1.41 (95% CI: 1.10-1.81). Controlling only for co-morbidities (model Ⅱ), AOR for hip fracture associated with PPI therapy was 1.43 (95% CI: 1.13-1.81). The risk of hip fracture was significantly increased among patients prescribed high-dose PPIs. The strength of the association increased with increasing dose of PPI therapy [AOR for low-dose: 0.87(95% CI: 0.58-1.30); median-dose: 1.37(95% CI: 0.88-2.15); high-dose: 2.13(95% CI: 1.44-3.15); test for trend, p=0.002]. There was no association between H2RAs therapy and risk of hip fracture. Conclusion: Use of high-dose PPIs (>70 DDDs) is associated with an increased risk of hip fracture.