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Use of proton pump inhibitors and mortality after hip fracture in a nationwide study

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Abstract

Summary

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.

Introduction

We herein investigated use of proton pump inhibitors (PPIs) and mortality among hip fracture patients in a nationwide study in Austria.

Methods

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.

Results

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.

Conclusions

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.

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Acknowledgements

We thank Katrin Danninger (OÖGKK), Alexandra Ferdin (BVA), Jana Fischer (NÖGKK), Peter Haubenberger (SVA), Michael Hueber (VAEB), Renato Kasseroller (SGKK), Claudia Kastelic (SVB), Tobias Lingenhöle (VGKK), Ursula Riess (KGKK), Marianne Schmid (StGKK), Cornelia Siess (WGKK), and Norbert Thiemann (TGKK) from the Austrian social insurance authorities for provision of the data.

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Authors and Affiliations

  1. 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

    W. Brozek, J. Zwerina, K. Klaushofer & E. Zwettler

  2. Sickness Fund Burgenland, Burgenländische Gebietskrankenkasse, Esterhazyplatz 3, 7000, Eisenstadt, Austria

    B. Reichardt

  3. Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria

    H. P. Dimai

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  1. W. Brozek
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  2. B. Reichardt
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  3. J. Zwerina
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  4. H. P. Dimai
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Correspondence to W. Brozek.

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The local ethics committee approved the study which was performed in agreement with the Declaration of Helsinki.

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Brozek, W., Reichardt, B., Zwerina, J. et al. Use of proton pump inhibitors and mortality after hip fracture in a nationwide study. Osteoporos Int 28, 1587–1595 (2017). https://doi.org/10.1007/s00198-017-3910-x

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  • DOI: https://doi.org/10.1007/s00198-017-3910-x

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