Use of proton pump inhibitors and risk of osteoporosisrelated fractures
Use of proton pump inhibitors and risk of osteoporosisrelated fractures
复制标题
DOI：
10.1503/cmaj.071330
复制
发表时间：
2008-08-12
影响因子：
14.6
通讯作者：
Leslie, William D.
中科院分区：
文献类型：
--
作者：
Targownik, Laura E.;Lix, Lisa M.;Leslie, William D.
背景：质子泵抑制剂的使用与髋部骨折风险增加有关。我们试图进一步探讨质子泵抑制剂暴露时间与骨质疏松症相关骨折之间的关系。方法：我们使用行政索赔数据来识别 1996 年 4 月至 2004 年 3 月期间发生髋部、椎骨或腕部骨折的患者。根据年龄、性别和合并症，将每个病例与 3 个对照进行匹配。我们计算了质子泵抑制剂暴露时间从 1 年或以上到 7 年以上的髋部骨折和所有骨质疏松相关骨折风险的调整优势比 (OR)。 结果：我们将 15 792 例骨质疏松相关骨折病例与 47 289 例对照进行匹配。我们没有发现骨质疏松性骨折的总体风险与质子泵抑制剂使用时间不超过 6 年之间存在显着关联。然而，暴露 7 年或以上与骨质疏松相关骨折的风险增加相关（调整后 OR 1.92，95% 置信区间 [CI] 1.16-3.18，p = 0.011）。我们还发现，暴露 5 年或以上后髋部骨折的风险增加（调整后 OR 1.62，95% CI 1.02-2.58，p = 0.04），暴露 7 年或以上后风险甚至更高（调整后 OR 4.55，95% CI 1.68-12.29，p = 0.002）。解释：使用质子泵抑制剂 7 年或以上与骨质疏松症相关骨折的风险显着增加有关。暴露 5 年或更长时间后，髋部骨折的风险会增加。需要进一步的研究来确定这一发现的临床重要性，并确定骨保护药物对于长期使用质子泵抑制剂的患者的价值。
Background: The use of proton pump inhibitors has been associated with an increased risk of hip fracture. We sought to further explore the relation between duration of exposure to proton pump inhibitors and osteoporosis-related fractures.Methods: We used administrative claims data to identify patients with a fracture of the hip, vertebra or wrist between April 1996 and March 2004. Cases were each matched with 3 controls based on age, sex and comorbidities. We calculated adjusted odds ratios (OR) for the risk of hip fracture and all osteoporosis- related fractures for durations of proton pump inhibitor exposure ranging from 1 or more years to more than 7 years.Results: We matched 15 792 cases of osteoporosis- related fractures with 47 289 controls. We did not detect a significant association between the overall risk of an osteoportic fracture and the use of proton pump inhibitors for durations of 6 years or less. However, exposure of 7 or more years was associated with increased risk of an osteoporosisrelated fracture (adjusted OR 1.92, 95% confidence interval [CI] 1.16-3.18, p = 0.011). We also found an increased risk of hip fracture after 5 or more years of exposure (adjusted OR 1.62, 95% CI 1.02-2.58, p = 0.04), with even higher risk after 7 or more years exposure (adjusted OR 4.55, 95% CI 1.68-12.29, p = 0.002).Interpretation: Use of proton pump inhibitors for 7 or more years is associated with a significantly increased risk of an osteoporosis- related fracture. There is an increased risk of hip fracture after 5 or more years exposure. Further study is required to determine the clinical importance of this finding and to determine the value of osteoprotective medications for patients with long-term use of proton pump inhibitors.