The Relationship Between Proton Pump Inhibitor Adherence and Fracture Risk in the Elderly

Studies suggest that long-term use of proton pump inhibitors (PPIs) may be associated with an increased risk of fracture. However, the role of medication adherence in this association is not fully understood. A retrospective cohort study was conducted to examine the relationship between PPI use/adhe...

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Bibliographic Details
Published in:Calcified tissue international 2014-06, Vol.94 (6), p.597-607
Main Authors: Ding, Jian, Heller, Debra A., Ahern, Frank M., Brown, Theresa V.
Format: Article
Language:English
Subjects:
Aged
Aged, 80 and over
Biochemistry
Biomedical and Life Sciences
Cell Biology
Cohort Studies
Drug use
Endocrinology
Female
Fractures
Fractures, Bone - epidemiology
Humans
Life Sciences
Male
Medication Adherence
Older people
Original Research
Orthopedics
Osteoporosis
Pharmacology
Proportional Hazards Models
Proton Pump Inhibitors - adverse effects
Retrospective Studies
Risk Factors
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Summary:Studies suggest that long-term use of proton pump inhibitors (PPIs) may be associated with an increased risk of fracture. However, the role of medication adherence in this association is not fully understood. A retrospective cohort study was conducted to examine the relationship between PPI use/adherence and fracture risk among elderly subjects by combining administrative pharmacy claims data, survey data, and Medicare data. The study cohort included 1,604 PPI users and 23,672 nonusers who were enrolled in Pennsylvania’s Pharmaceutical Assistance Contract for the Elderly program. PPI adherence was measured by the proportion of days covered (PDC). Time-dependent Cox proportional hazards models were used to estimate adjusted hazard ratios (HRs) of PPI use/adherence for fracture risk while controlling for demographics, comorbidity, body mass index, smoking, and non-PPI medication use. The overall incidence of any fracture per 100 person-years was 8.7 for PPI users and 5.0 for nonusers. A gradient in fracture risk according to PPI adherence was observed. Relative to nonusers, fracture HRs associated with the highest (PDC ≥ 0.80), intermediate (PDC 0.40–0.79), and lowest (PDC
ISSN:0171-967X
1432-0827
DOI:10.1007/s00223-014-9855-6