Proton pump inhibitor use and risk of hip fractures in patients without major risk factors
Proton pump inhibitor use and risk of hip fractures in patients without major risk factors
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DOI：
10.1592/phco.28.8.951
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发表时间：
2008-08-01
期刊：
影响因子：
4.1
通讯作者：
Jick, Hershel
中科院分区：
文献类型：
--
作者：
Kaye, James A.;Jick, Hershel
研究目的。在无主要危险因素的人群中估计与质子泵抑制剂（PPI）使用相关的髋部骨折的相对风险。一项两阶段、匹配、巢式病例对照研究。数据来源。英国全科医学研究数据库（GPRD）。I期研究确定了4414例在1995年至2005年期间发生髋部骨折的病例患者（年龄50-79岁），这些患者在GPRD中至少有2年的记录病史;每个病例的年龄、性别和索引日期（病例首次髋部骨折的日期，匹配对照组的相同日期）与最多10例未发生髋部骨折的对照组相匹配。第2阶段包括1098例被确定为没有髋部骨折主要医学风险因素的患者（如第1阶段所评估的）和一组新的10,923例对照组，这些对照组没有髋部骨折的主要风险因素，这些因素与GPRD中的性别、年龄、索引日期和病史持续时间相匹配。在第1阶段，我们确定了髋部骨折的主要医疗风险因素。在第二阶段，我们将研究限制在没有这些危险因素的病例患者中，并将他们与新的对照组相匹配，这些对照组也没有任何危险因素。收集了PPI使用的数据，并在两组之间进行了比较。接受任何PPI处方的患者与未接受PPI处方的患者相比，髋部骨折的相对风险（RR）为0.9（95%置信区间0.7-1.1）。我们没有发现增加PPI使用会增加髋部骨折风险的证据。两种性别和所有年龄亚组的RR估计值相似。没有特异性PPI与髋关节置换风险增加相关。PPI的使用不会增加无主要风险因素患者的髋部骨折风险。我们的研究与另一项研究之间的结果差异表明，PPI的使用增加了髋部骨折的风险，这可能是由于后一项研究中的残留混杂因素或效应修改。
Study Objective. To estimate the relative risk of hip fracture associated with proton pump inhibitor (PPI) use in a population without major risk factors.Design. A two-phase, matched, nested case-control study.Data Source. United Kingdom General Practice Research Database (GPRD).Patients. Phase I identified 4414 case patients (aged 50-79 yrs) with an incident hip fracture between 1995 and 2005 who had at least 2 years of recorded history in the GPRD; each case was matched by age, sex, and index date (date of first-time hip fracture for cases, same date for matched controls) to up to 10 controls who did not have hip fracture. Phase 2 included the 1098 case patients identified as having no major medical risk factors for hip fracture (as assessed in phase 1) and a new set of 10,923 controls without major risk factors for hip fracture matched by sex, age, index date, and duration of history in the GPRD.Measurements and Main Results. In phase 1, we identified major medical risk factors for hip fracture. In phase 2, we restricted the study to case patients with none of these risk factors and matched them to new controls, who also had none of the risk factors. Data on use of PPIs were collected and compared between the groups. The relative risk (RR) for hip fracture among patients who received any PPI prescription was 0.9 (95% confidence interval 0.7-1.1) compared with those with no PPI prescription. We found no evidence of an increased risk of hip fracture with increased PPI use. The RR estimates were similar in both sexes and in all age subgroups. No specific PPI was associated with an increased risk of hip fracture.Conclusion. Use of PPIs does not increase the risk of hip fracture in patients without major risk factors. The difference in results between our study and that of another, which indicated that PPI use increases the risk of hip fracture, may be due to residual confounding or effect modification in the latter study.