Fedida Benjamin, Schermann Haggai, Ankory Ran, Rotman Dani, Shichman Ittai, Yoffe Vicky, Shlaifer Amir, Luger Elhanan
Division of Orthopedics, Tel Aviv Sourasky Medical Center affiliated with Tel Aviv University, Tel Aviv, Israel.
Medical Corps, Israeli Defence Forces, Tel Aviv, Israel.
Int J Clin Pract. 2019 May;73(5):e13339. doi: 10.1111/ijcp.13339. Epub 2019 Mar 27.
Proton-pump inhibitors (PPI) and histamine (type 2) receptor antagonists (H2RA) have the potential to interfere with calcium metabolism. Several authors have evaluated the effect of these medications on fracture incidence in older adults. A recent large epidemiologic study demonstrated a higher risk of fractures in young adults receiving PPI.
To evaluate the effect of PPI and H2RA use on fracture incidence in a large retrospective cohort of military recruits representative of general population of young adults.
A retrospective cohort of 254 265 male and 234 670 female non-combat military conscripts ages 18-25. Subjects were divided into three groups by PPI use (no PPI use, 1-100 tablets and more than 100 tablets) and two groups by H2RA use (no H2RA use, any H2RA use). Multivariate logistic regression was used to adjust fracture risk for age, BMI, education level, socio-economic level, ethnic origin, occupation and duration of follow-up in months.
At least one fracture during the study period.
Use of PPI and H2RA was not associated with an increased risk of fractures. In men, the predictors of an increased fracture risk were higher BMI (OR = 1.007, P < 0.001), origin from a developing country (OR = 1.15, P < 0.001) and service as a driver (OR = 1.11, P < 0.001). Higher education, higher socioeconomic status and service as an officer or as an administrative worker had a protective effect on fracture incidence. In women, fractures were associated with higher BMI (OR = 1.035, P < 0.001). Origin from a developed country, as well as service as an officer or an administrative worker was associated with lower fracture risk.
There was no association between the use of PPI or H2-antagonists and fracture incidence in this retrospective cohort of healthy young military recruits.
质子泵抑制剂（PPI）和组胺（2型）受体拮抗剂（H2RA）有可能干扰钙代谢。几位作者评估了这些药物对老年人骨折发生率的影响。最近一项大型流行病学研究表明，服用PPI的年轻人骨折风险更高。
在一个代表年轻成年人总体人群的大型军事新兵回顾性队列中，评估使用PPI和H2RA对骨折发生率的影响。
对254265名年龄在18至25岁的男性和234670名女性非战斗军事应征者进行回顾性队列研究。根据PPI使用情况（未使用PPI、使用1 - 100片和使用超过100片）将受试者分为三组，根据H2RA使用情况（未使用H2RA、使用任何H2RA）分为两组。采用多因素逻辑回归分析来调整年龄、体重指数（BMI）、教育水平、社会经济水平、种族、职业以及随访月数对骨折风险的影响。
研究期间至少发生一次骨折。
使用PPI和H2RA与骨折风险增加无关。在男性中，骨折风险增加的预测因素包括较高的BMI（比值比[OR]=1.007，P<0.001）、来自发展中国家（OR = 1.15，P<0.001）以及担任司机（OR = 1.11，P<0.001）。高等教育、较高的社会经济地位以及担任军官或行政人员对骨折发生率有保护作用。在女性中，骨折与较高的BMI相关（OR = 1.035，P<0.001）。来自发达国家以及担任军官或行政人员与较低的骨折风险相关。
在这个健康年轻军事新兵的回顾性队列中，使用PPI或H2拮抗剂与骨折发生率之间没有关联。
