Proton pump inhibitors and the risk of fractures in older adults: a population-based retrospective cohort study

OBJECTIVES: To examine the association between proton pump inhibitor (PPI) use and the incidence of fractures. DESIGN: Prospective population-based cohort SETTING: Group Health, an integrated health maintenance organization in Seattle, WA using data from 1994-2014. PARTICIPANTS: Four thousand four hundred and forty-one participants aged 65 and older who had not sustained a fracture in the year prior to study enrollment. MEASUREMENTS: Follow-up occurred every 2 years to identify incident fractures using ICD-9 codes from medical records for fractures of the hip, forearm, humerus, clavicle or scapula, rib or sternum, tibia or fibula, or ankle. Exposure to PPIs was determined from automated pharmacy data. Cumulative exposure (time-varying) was examined based on summing SDDs across all fills. RESULTS: Over a mean follow-up of 5.9 years, 764 subjects experienced a fracture. No overall association was found between cumulative PPI use and risk of fracture . The adjusted HR comparing various groups to the reference group (≤ 30 standard daily doses (SDD)) was 1.08 (95% CI 0.83-1.42) for those with little use (31-540 SDD), 1.41 (95% CI 0.94-2.14) for moderate use (541-1080 SDD), and 1.10 (95% CI 0.78-1.55) for heavy use (≥1081 SDD). CONCLUSION: No association was found between PPI use and risk of fractures among older adults .