Korean Journal of Clinical Pharmacy (한국임상약학회지)

Korean College Of Clinical Pharmacy (한국임상약학회)
권호 표지
DOI QR코드

DOI QR Code

Association of Proton Pump Inhibitor Use and Risk of Fracture Based on the National Health Insurance Sample Cohort Database (2002~2013)

국민건강보험 12년 표본코호트자료를 이용한 프로톤펌프억제제 사용과 골절 위험의 연관성

  • Kim, Jong Joo (Pharmaceutical Information Research Institute, Cha University) ;
  • Jang, Eun Jin (Collage of Natural Science, Andong National University) ;
  • Cho, Junwoo (Collage of Natural Science, Kyungpook National University) ;
  • Sohn, Hyun Soon (Collage of Pharmacy, CHA University)
  • 김종주 (차의과학대학교 약료정보연구원) ;
  • 장은진 (안동대학교 자연과학대학) ;
  • 조준우 (경북대학교 자연과학대학) ;
  • 손현순 (차의과학대학교 약학대학)
  • Received : 2019.05.01
  • Accepted : 2019.06.20
  • Published : 2019.09.30
Download PDF
⟨ Previous Next ⟩

Abstract

Objectives: The purpose of this study was to investigate the association between fracture risk and proton pump inhibitor (PPI) use to establish evidence for defining high-risk groups of fracture among PPI users. Methods: A case-control study was performed using the National Health Insurance Sample Cohort Database from January 2002 to December 2013. The cases included all incidences of major fractures identified from January 2011 to December 2013, and up to four controls were matched to each case by age, gender, osteoporosis, and Charlson comorbidity index. Conditional logistic regression was used to calculate the adjusted odds ratio (aOR) and associated 95% confidence interval (CI). Results: Overall, 14,295 cases were identified, and 63,435 controls were matched to the cases. The aOR of fractures related to the use of PPIs was 1.06 (95% CI: 1.01-1.11). There was a statistically significant association between fracture and PPI use within 3 months of the last dose, and a trend of increasing fracture risk with increasing cumulative PPI dose. The risk of fracture was significantly higher in patients who took PPIs for more than 1 year during the 2-year observation period. Conclusion: Patients who have been using PPIs for more than 1 year should be warned about the risk of fracture during or at least 3 months after discontinuing the PPI.

Keywords

References

  1. van Pinxteren B, Sigterman KE, Bonis P, Lau J, Numans ME. Short-term treatment with proton pump inhibitors, H2-receptor antagonists and prokinetics for gastro-oesophageal reflux disease-like symptoms and endoscopy negative reflux disease. Cochrane Database Syst Rev. 2010 Nov 10;(11):CD002095. doi: 10.1002/14651858.CD002095.
  2. Malfertheiner P, Kandulski A, Venerito M. Proton-pump inhibitors: understanding the complications and risks. Nat Rev Gastroenterol Hepatol 2017;14(12):697-710. https://doi.org/10.1038/nrgastro.2017.117
  3. Kim JJ, Jang EJ, Kim DH, Park H, Sohn HS. Proton pump inhibitors' use in Korea based on the National Health Insurance Sample Cohort Database (2002-2013). Yakhak Hoeji 2018;62(3):171-8. https://doi.org/10.17480/psk.2018.62.3.171
  4. Health Insurance Review and Assessment Service: Healthcare Bigdata Hub. Statistics. Available from http://opendata.hira.or.kr/op/opc/olapMsupInfo.do. Accessed January 16, 2018.
  5. Bhatt DL, Scheiman J, Abraham NS, et al. ACCF/ACG/AHA 2008 expert consensus document on reducing the gastrointestinal risks of antiplatelet therapy and NSAID use: a report of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents. Circulation 2008;118:1894-909. https://doi.org/10.1161/CIRCULATIONAHA.108.191087
  6. Lee J, Youn KE, Choi NK, et al. A population-based case-control study: proton pump inhibition and risk of hip fracture by use of bisphosphonate. J Gastroenterol 2013;48:1016-22. https://doi.org/10.1007/s00535-012-0722-9
  7. Drug safety communications. Ministry of food and drug safety. Pharmaceutical safety bureau. 2012.02.10. Available from http://www.mfds.go.kr/index.do?x=0&searchkey=title:contents2&mid=1034&page=null&searchword= 프로톤 &y=0&pageNo=1&seq=52&cmd=v. Accessed March 05, 2019.
  8. Cosman F, de Beur SJ, LeBoff MS, et al. Clinician's guide to prevention and treatment of osteoporosis. Osteoporos Int 2014;25:2359-81. https://doi.org/10.1007/s00198-014-2794-2
  9. Eom CS, Park SM, Myung SK, Yun JM, Ahn JS. Use of acid-suppressive drugs and risk of fracture: a meta-analysis of observational studies. Ann Fam Med 2011;9:257-67. https://doi.org/10.1370/afm.1243
  10. Zhou B, Huang Y, Li H, Sun W, Liu J. Proton-pump inhibitors and risk of fractures: an update meta-analysis. Osteoporos Int 2016;27:339-47. https://doi.org/10.1007/s00198-015-3365-x
  11. Nassar Y and Richter S. Proton-pump inhibitor use and fracture risk: an updated systematic review and meta-analysis. J Bone Metab 2018;25:141-51. https://doi.org/10.11005/jbm.2018.25.3.141
  12. Rhee J, Kim DH, Yu SY, et al. Proton pump inhibitor use and risk of osteoporotic fracture in Korean adults with peptic ulcer disease and gastroesophageal reflux disease. National evidence based healthcare collaborating agency. 2018. Available from https://www.neca.re.kr/lay1/program/S1T11C145/report/view.do?seq=249. Accessed March 05, 2019.
  13. Heidelbaugh JJ. Proton pump inhibitors and risk of vitamin and mineral deficiency: evidence and clinical implications. Ther Adv Drug Saf 2013;4:125-33. https://doi.org/10.1177/2042098613482484
  14. Costa-Rodrigues J, Reis S, Teixeira S, Lopes S, Femandes MH. Dose-dependent inhibitory effects of proton pump inhibitors on human osteoclastic and osteoblastic cell activity. FEBS J 2013;280:5052-64. https://doi.org/10.1111/febs.12478
  15. Sheraly AR, Lickorish D, Sarraf F, Davies JE. Use of gastrointestinal proton pump inhibitors to regulate osteoclastmediated resorption of calcium phosphate cements in vivo. Curr Drug Deliv 2009;6:192-8. https://doi.org/10.2174/156720109787846225
  16. Sugiyama T, Watarai K, Oda T, Kim YT, Oda H. Proton pump inhibitors and fracture: they impair bone quality and increase fall risk? Osteoporos Int 2016;27:1675-6. https://doi.org/10.1007/s00198-016-3509-7
  17. Liu J, Li X, Fan L, et al. Proton pump inhibitors therapy and risk of bone diseases: An update meta-analysis. Life Sci 2019;218:213-23. https://doi.org/10.1016/j.lfs.2018.12.058