Division of Gastroenterology, Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea.
Institute for Liver and Digestive Diseases, Hallym University, Chuncheon, South Korea.
J Gastroenterol Hepatol. 2022 Aug;37(8):1534-1543. doi: 10.1111/jgh.15879. Epub 2022 May 11.
Association between protonpump inhibitors (PPIs) and osteoporosis, hip fractures has not been fully elucidated. We aimed to evaluate the relationship between PPIs use and the risk of osteoporosis and hip fractures in the databases converted to a common data model (CDM) and to compare the results across the databases.
This was a population-based, propensity-matched, retrospective cohort study that included patients aged ≥ 50 years who were prescribed with PPIs for over 180 days. We compared the incidence of osteoporosis and hip fractures between new PPI user and new user of other drugs using the Cox proportional hazards model and performed meta-analysis in the electronic health record (EHR) databases.
In the Korean National Health Insurance Service (NHIS)-CDM database, long-term PPI users had greater risk of osteoporosis [PPIs vs non-PPIs groups, 28.42/1000 person-years vs 19.29/1000 person-years; hazard ratio (HR), 1.62; 95% confidence interval (CI), 1.22-2.15; P = 0.001]. The meta-analytic results of six EHR databases also showed similar result (pooled HR, 1.57; 95% CI, 1.28-1.92). In the analysis of hip fracture, PPI use was not significantly associated with a hip fracture in the NHIS-CDM database (PPI vs non-PPI groups, 3.09/1000 person-years vs 2.26/1000 person-years; HR, 1.45; 95% CI, 0.74-2.80; P = 0.27). However, in the meta-analysis of four EHR databases, the risk of hip fractures was higher in PPI users (pooled HR, 1.82; 95% CI, 1.04-3.19).
Long-term PPI was significantly associated with osteoporosis; however, the results of hip fractures were inconsistent. Further study based on better data quality may be needed.
质子泵抑制剂（PPIs）与骨质疏松症、髋部骨折之间的关联尚未完全阐明。我们旨在评估数据库转换为通用数据模型（CDM）后 PPI 使用与骨质疏松症和髋部骨折风险之间的关系，并比较数据库之间的结果。
这是一项基于人群的、倾向匹配的回顾性队列研究，纳入了年龄≥50 岁、使用 PPI 治疗超过 180 天的患者。我们使用 Cox 比例风险模型比较了新 PPI 使用者和其他药物新使用者之间骨质疏松症和髋部骨折的发生率，并在电子健康记录（EHR）数据库中进行了荟萃分析。
在韩国国家健康保险服务（NHIS）-CDM 数据库中，长期使用 PPI 的患者发生骨质疏松症的风险更高[PPI 组与非 PPI 组，28.42/1000 人年比 19.29/1000 人年；风险比（HR），1.62；95%置信区间（CI），1.22-2.15；P=0.001]。六个 EHR 数据库的荟萃分析结果也显示出类似的结果（汇总 HR，1.57；95%CI，1.28-1.92）。在 NHIS-CDM 数据库中，分析髋部骨折时，PPI 使用与髋部骨折无显著相关性（PPI 组与非 PPI 组，3.09/1000 人年比 2.26/1000 人年；HR，1.45；95%CI，0.74-2.80；P=0.27）。然而，在四个 EHR 数据库的荟萃分析中，PPI 使用者髋部骨折的风险更高（汇总 HR，1.82；95%CI，1.04-3.19）。
长期使用 PPI 与骨质疏松症显著相关；然而，髋部骨折的结果不一致。可能需要基于更好数据质量的进一步研究。
