Brozek W, Reichardt B, Zwerina J, Dimai H P, Klaushofer K, Zwettler E
Ludwig Boltzmann Institute of Osteology, Hanusch Hospital of the WGKK and AUVA Trauma Center, 1st Medical Department at Hanusch Hospital, Heinrich Collin Str. 30, 1140, Vienna, Austria.
Sickness Fund Burgenland, Burgenländische Gebietskrankenkasse, Esterhazyplatz 3, 7000, Eisenstadt, Austria.
Osteoporos Int. 2017 May;28(5):1587-1595. doi: 10.1007/s00198-017-3910-x. Epub 2017 Jan 12.
We analyzed the association of proton pump inhibitors (PPIs) with mortality after osteoporosis-related hip fracture in Austria. PPIs were associated with reduced 90-day mortality but elevated mortality after half a year when initiated pre-fracture. Inpatients and discharged patients on PPIs showed lowered in-hospital and 90-day mortality, respectively.
We herein investigated use of proton pump inhibitors (PPIs) and mortality among hip fracture patients in a nationwide study in Austria.
In this retrospective cohort study, data on use of PPIs were obtained from 31,668 Austrian patients ≥50 years with a hip fracture between July 2008 and December 2010. All-cause mortality in patients without anti-osteoporotic drug treatment who had received their first recorded PPI prescription in the study period either before or after fracture was compared with hip fracture patients on neither PPIs nor anti-osteoporotic medication using logistic and Cox regression analysis.
With PPI use, 90-day mortality was significantly reduced, both at initiation before (OR 0.66; p < 0.0001) and after hip fracture (OR 0.23; p < 0.0001). 90-day mortality was also reduced when PPIs were prescribed not until after discharge from the last recorded hip fracture-related hospital stay (OR 0.49; p < 0.0001) except for patients aged <70 years. In a sub-cohort of patients beginning PPIs during hospital stay, in-hospital mortality (0.2%) was substantially reduced relative to matched control patients (3.5%) (p < 0.0001). Longer-term mortality significantly increased after half a year post-fracture only among those who started PPI prescription before fracture.
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.
我们分析了奥地利质子泵抑制剂（PPI）与骨质疏松相关髋部骨折后死亡率之间的关联。PPI与90天死亡率降低相关，但骨折前开始使用时，半年后死亡率升高。使用PPI的住院患者和出院患者分别显示住院期间和90天死亡率降低。
我们在奥地利的一项全国性研究中调查了髋部骨折患者使用质子泵抑制剂（PPI）的情况及死亡率。
在这项回顾性队列研究中，从2008年7月至2010年12月期间31668名年龄≥50岁的奥地利髋部骨折患者中获取PPI使用数据。使用逻辑回归和Cox回归分析，将在研究期间骨折前或骨折后首次记录PPI处方且未接受抗骨质疏松药物治疗的患者的全因死亡率，与既未使用PPI也未使用抗骨质疏松药物的髋部骨折患者进行比较。
使用PPI时，骨折前开始使用（比值比0.66；p＜0.0001）和骨折后开始使用（比值比0.23；p＜0.0001），90天死亡率均显著降低。除年龄＜70岁的患者外，直到最后一次记录的与髋部骨折相关的住院出院后才开具PPI处方时，90天死亡率也降低（比值比0.49；p＜0.0001）。在住院期间开始使用PPI的患者亚组中，住院死亡率（0.2%）相对于匹配的对照患者（3.5%）大幅降低（p＜0.0001）。仅在骨折前开始PPI处方的患者中，骨折后半年以上的长期死亡率显著增加。
髋部骨折住院期间及出院后使用PPI与死亡率显著降低相关。这些发现可能对髋部骨折治疗有影响。
