Comparing proton pump inhibitors with histamin-2 receptor blockers regarding the risk of osteoporotic fractures: a nested case-control study of more than 350,000 Korean patients with GERD and peptic ulcer disease

• Published in: BMC geriatrics 2020-10, Vol.20 (1), p.407-11, Article 407
• Main Authors: Park, Joo-Hyun, Lee, Jessie, Yu, Su-Yeon, Jung, Jin-Hyung, Han, Kyungdo, Kim, Do-Hoon, Rhee, Jinnie
• Format: Article
• Language: English
• Subjects: Age; Aged; Aged, 80 and over; Anti-Ulcer Agents - administration & dosage; Anti-Ulcer Agents - adverse effects; Bisphosphonates; Body mass index; Case-Control Studies; Enzyme Inhibitors - administration & dosage; Enzyme Inhibitors - adverse effects; Exercise; Female; Fracture; Fractures; Gastroesophageal reflux; Gastroesophageal Reflux - drug therapy; Gastroesophageal Reflux - epidemiology; Gastroesophageal reflux disease; Geriatrics; Histamine H2 Antagonists - administration & dosage; Histamine H2 Antagonists - adverse effects; Histamine H2 receptors; Hormone replacement therapy; Humans; Male; Medical screening; Older people; Osteoporosis; Osteoporotic Fractures - chemically induced; Osteoporotic Fractures - epidemiology; Peptic Ulcer - drug therapy; Peptic Ulcer - epidemiology; Peptic ulcer disease; Peptic ulcers; Physical fitness; Population Surveillance; Prescription drugs; Proton pump inhibitors; Proton Pump Inhibitors - administration & dosage; Proton Pump Inhibitors - adverse effects; Proton-pump inhibitor; Republic of Korea - epidemiology; Risk factors; Sex ratio; Treatment Outcome; Ulcers
• ISSN: 1471-2318; 1471-2318
• DOI: 10.1186/s12877-020-01794-3

Patients with peptic ulcer disease (PUD) and gastroesophageal reflux disease (GERD) are more likely to receive long-term therapy with proton pump inhibitors (PPIs). This study aimed to investigate the risk of osteoporotic fractures in PPI users compared to histamine-2 receptor antagonist (H2RA) users and the association between fractures and the duration and regular use of PPI. A population-based, nationwide nested case-control study from January 2006 to December 2015 was performed using Korean National Health Insurance Service claims data. We included patients ≥50 years of age, without previous fractures, newly prescribed with PPI or H2RA, and diagnosed with PUD or GERD from 2006 to 2015. Patients with osteoporotic fracture (n = 59,240) were matched with the non-fracture control group (n = 296,200) at a 1:5 ratio based on sex, age, cohort entry date, follow-up duration, and bisphosphonate use. The osteoporotic fractures were defined using the diagnostic codes of claims data (M80, M81, M82, M484, M485, S220, S221, S320, S327, S422, S423, S525, S526, S72). The higher the cumulative use of PPIs, the higher the osteoporotic fracture risk (P for trend