Abstract: SA-PO660
Proton Pump Inhibitors, But Not Histamine-2 Receptor Antagonists, Associate with Hip Fracture Risk Among Patients on Hemodialysis
Session Information
- Bone and Mineral Metabolism: Clinical - II
October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Bone and Mineral Metabolism
- 402 Bone and Mineral Metabolism: Clinical
Authors
- Vangala, Chandan, Baylor College of Medicine, Houston, Texas, United States
- Niu, Jingbo, Baylor College of Medicine, Houston, Texas, United States
- Mitch, William E., Baylor College of Medicine, Houston, Texas, United States
- Navaneethan, Sankar D., Baylor College of Medicine, Houston, Texas, United States
- Winkelmayer, Wolfgang C., Baylor College of Medicine, Houston, Texas, United States
Background
An association between proton pump inhibitor (PPI) use and hip fracture risk has been described in the general population, where the primary causative hypothesis focuses on impaired gastrointestinal calcium absorption. The impact of acid suppressor use on hip fracture risk in a high-risk subset, patients with end-stage kidney disease requiring hemodialysis, is unknown and could help further distinguish the reason for increased susceptibility among PPI users.
Methods
Using the U.S. Renal Data System (USRDS), we identified all hip fracture events recorded between 2009 and 2014 among hemodialysis-dependent patients. Eligible cases were matched on index date with 10 controls. We identified PPI and histamine-2 receptor antagonist use from Medicare Part D claims covering 3 years prior to index date and stratified according to proportion of days covered by filled prescriptions. Using logistic regression with multiple imputation for missing data, we estimated unadjusted and multivariable-adjusted odds ratios (OR) and 95% confidence intervals (CI).
Results
We studied 4,551 cases and 45,510 controls. Cases were older, more likely to be female and Caucasian, and had shorter dialysis vintage; fewer were obese. A larger proportion of cases had any prior PPI (70% vs. 63%) or histamine-2 receptor antagonist (25% vs. 23%) use. Use of PPI was associated with higher risk of hip fracture (adjusted OR 1.19, 95% CI 1.11-1.28). This association remained within subgroups of low, moderate, and high PPI use, yielding adjusted ORs of 1.16 (1.06-1.27), 1.21 (1.11-1.31), and 1.20 (1.09-1.32), respectively.
Conclusion
Conclusion: Among patients with end-stage kidney disease on hemodialysis, PPIs, and not histamine-2 receptor antagonists, were associated with hip fracture events.
Funding
- Private Foundation Support