Disclosures: Labenz reports no relevant financial disclosures. Please see the full study for all other authors' relevant financial disclosures.
August 19, 2020
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PPIs associated with bone fractures in men with cirrhosis

Disclosures: Labenz reports no relevant financial disclosures. Please see the full study for all other authors' relevant financial disclosures.
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Use of proton pump inhibitors had a dose-dependent association with bone fractures in men with cirrhosis, according to study results.

Christian Labenz, of University Medical Centre of the Johannes Gutenberg-University in Germany, and colleagues wrote that fractures are among the complications that could trigger decompensation among patients with cirrhosis and highlighted the importance of finding potential ways to avert these events.

“Among the modifiable risk factors for bone fractures, the use of proton pump inhibitors has emerged in recent years form several studies both in the general population as well as in patients with chronic diseases,” they wrote. “At current, data related to the risk of fractures in patients with liver cirrhosis and the potential role of PPIs are lacking.”

Researchers conducted a population-based, case-control study to determine if PPI use predisposed patients with cirrhosis to bone fractures. Using data from the Disease Analyzer database, they compared 1,795 patients with cirrhosis with fractures with 10,235 patients with cirrhosis without fractures. They estimated the association using overall PPI use and PPI dose in the 5 years prior to index date.

Labenz and colleagues found that PPI use was more frequent in patients with fracture compared with those without (67% vs. 53.4%, P < .001), and after adjusting for confounders, PPI use was associated with bone fractures (OR = 1.34; 95% CI, 1.2-1.51).

Investigators also observed a dose-dependent effect for all PPIs with the strongest effect seen in patients with cirrhosis who received a dose greater than 50,000 mg during the 5 years prior to index date (OR = 1.63; 95% CI, 1.32-2.03). Additionally, they observed the strongest effect of PPIs on bone fractures among men aged younger than 70 years.

“Our study demonstrates a moderate association between PPI use and a higher risk of fractures in a large cohort of patients with liver cirrhosis,” Labenz and colleagues wrote. “Considering the health burden caused by bone fractures, it is of importance that in the management of patients with liver cirrhosis, the use of PPIs should be performed after careful risk-benefit assessment.”