Short Term Proton Pump Inhibitor Use Can Increase Risk of Hip Fracture in Elderly Alzheimer Patients

6 Jun, 18

Introduction

Proton pump inhibitors (PPIs) are commonly used by the older population. PPIs have been linked to serious adverse events, fractures being one of them. Hip fractures in older persons with Alzheimer's disease is a cause of concern. In addition to this, the older persons usually use many concomitant drugs for several diseases, which further increase the risk factors. However, there are no studies which assess whether the current use, duration of current use past use or cumulative use of PPIs increase the risk of hip fractures in older persons with Alzheimer’s disease.

Aim

The current study assessed whether long term PPI use elevated the risk of hip fractures in community-dwelling persons with Alzheimer's disease.

Method

Study design

Nested case control study
Nationwide (Medication use and Alzheimer’s disease) MEDALZ data was used
4818 older subjects (mean age 84.1 years), with Alzheimer's disease who encountered incident hip fracture were identified
Each case was matched to 4 controls at the date of hip fracture
The subjects using PPIs during 0-30 days before the index date were defined as “current users”
If the PPI use period was ongoing before 31-90 days of index date, the users were defined as “past users”
If the PPIs were used during 10 years before the enrollment, the users were termed “ever users”
The current ongoing use of PPIs during 0-30 days before the index date, and cumulative duration of use during 10 years before the enrollment was analyzed
Conditional logistic regression models were used to evaluate the association between PPI use and risk of hip fractures

Results

Mean age of cases (n=4818) was 84.1 years and controls (n=19,235) 84 years
35% of the cases and 20% of the controls had previous fractures
48% and 47% of the cases and controls respectively had c=used PPIs during 10 years before the index date
Cumulative PPI usage did not increase the risk of hip fractures in the users
20% of the cases and 17% of the controls were current users
Current PPI use was associated with increased risk of hip fractures (adjusted Odds Ratio 1.12), whereas the past use did not show any such association
The users with PPI usage for <1 year were at an increased risk of hip fractures (aOR 1.23). usage >1 year did not increase the risk of hip fractures

Conclusion

Long-term or cumulative PPI use was not associated with an increased risk of hip fracture in older persons with Alzheimer’s disease
Additionally, current PPI use increased the risk of hip fracture
The risk was elevated in subjects using PPIs for less than 1 year

Aliment Pharmacol Ther. 2018 Apr;47(8):1135-1142. Doi: 10.1111/apt.14589.