Proton pump inhibitor use, hip fracture, and change in bone mineral density in postmenopausal women: Results from the women's health initiative

Shelly L. Gray, Andrea Z. Lacroix, Joseph Larson, John Robbins, Jane A. Cauley, Joann E. Manson, Zhao Chen

Research output: Contribution to journalArticle

246 Citations (Scopus)

Abstract

Background: Proton pump inhibitor (PPI) medications have been inconsistently shown to be associated with osteoporotic fractures. We examined the association of PPI usewith bone outcomes (fracture, bone mineral density [BMD]). Methods: This prospective analysis included 161 806 postmenopausal women 50 to 79 years old, without history of hip fracture, enrolled in the Women's Health Initiative (WHI) Observational Study and Clinical Trials with a mean (SD) follow-up of 7.8 (1.6) years. Analyses were conducted for 130 487 women with complete information. Medication information was taken directly from drug containers during in-person interviews (baseline, year 3). The main outcome measures were self-reported fractures (hip [adjudicated], clinical spine, forearm or wrist, and total fractures) and for a subsample (3 densitometry sites), 3-year change in BMD. Results: During 1 005 126 person-years of follow-up, 1500 hip fractures, 4881 forearm or wrist fractures, 2315 clinical spine fractures, and 21 247 total fractures occurred. The multivariate-adjusted hazard ratios for current PPI use were 1.00 (95% confidence interval [CI], 0.71-1.40) for hip fracture, 1.47 (95% CI, 1.18-1.82) for clinical spine fracture, 1.26 (95% CI, 1.05-1.51) for forearm or wrist fracture, and 1.25 (95% CI, 1.15-1.36) for total fractures. The BMD measurements did not vary between PPI users and nonusers at baseline. Use of PPIs was associated with only a marginal effect on 3-year BMD change at the hip (P=.05) but not at other sites. Conclusion: Use of PPIs was not associated with hip fractures but wasmodestly associated with clinical spine, forearm or wrist, and total fractures.

Original languageEnglish (US)
Pages (from-to)765-771
Number of pages7
JournalArchives of Internal Medicine
Volume170
Issue number9
DOIs
StatePublished - May 10 2010

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Proton Pump Inhibitors
Hip Fractures
Women's Health
Bone Density
Wrist
Forearm
Spine
Confidence Intervals
Drug Packaging
Osteoporotic Fractures
Densitometry
Bone Fractures
Observational Studies
Hip
Outcome Assessment (Health Care)
Clinical Trials
Interviews

ASJC Scopus subject areas

  • Internal Medicine

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Proton pump inhibitor use, hip fracture, and change in bone mineral density in postmenopausal women : Results from the women's health initiative. / Gray, Shelly L.; Lacroix, Andrea Z.; Larson, Joseph; Robbins, John; Cauley, Jane A.; Manson, Joann E.; Chen, Zhao.

In: Archives of Internal Medicine, Vol. 170, No. 9, 10.05.2010, p. 765-771.

Research output: Contribution to journalArticle

Gray, Shelly L. ; Lacroix, Andrea Z. ; Larson, Joseph ; Robbins, John ; Cauley, Jane A. ; Manson, Joann E. ; Chen, Zhao. / Proton pump inhibitor use, hip fracture, and change in bone mineral density in postmenopausal women : Results from the women's health initiative. In: Archives of Internal Medicine. 2010 ; Vol. 170, No. 9. pp. 765-771.
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abstract = "Background: Proton pump inhibitor (PPI) medications have been inconsistently shown to be associated with osteoporotic fractures. We examined the association of PPI usewith bone outcomes (fracture, bone mineral density [BMD]). Methods: This prospective analysis included 161 806 postmenopausal women 50 to 79 years old, without history of hip fracture, enrolled in the Women's Health Initiative (WHI) Observational Study and Clinical Trials with a mean (SD) follow-up of 7.8 (1.6) years. Analyses were conducted for 130 487 women with complete information. Medication information was taken directly from drug containers during in-person interviews (baseline, year 3). The main outcome measures were self-reported fractures (hip [adjudicated], clinical spine, forearm or wrist, and total fractures) and for a subsample (3 densitometry sites), 3-year change in BMD. Results: During 1 005 126 person-years of follow-up, 1500 hip fractures, 4881 forearm or wrist fractures, 2315 clinical spine fractures, and 21 247 total fractures occurred. The multivariate-adjusted hazard ratios for current PPI use were 1.00 (95{\%} confidence interval [CI], 0.71-1.40) for hip fracture, 1.47 (95{\%} CI, 1.18-1.82) for clinical spine fracture, 1.26 (95{\%} CI, 1.05-1.51) for forearm or wrist fracture, and 1.25 (95{\%} CI, 1.15-1.36) for total fractures. The BMD measurements did not vary between PPI users and nonusers at baseline. Use of PPIs was associated with only a marginal effect on 3-year BMD change at the hip (P=.05) but not at other sites. Conclusion: Use of PPIs was not associated with hip fractures but wasmodestly associated with clinical spine, forearm or wrist, and total fractures.",
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AU - Gray, Shelly L.

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AU - Cauley, Jane A.

AU - Manson, Joann E.

AU - Chen, Zhao

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N2 - Background: Proton pump inhibitor (PPI) medications have been inconsistently shown to be associated with osteoporotic fractures. We examined the association of PPI usewith bone outcomes (fracture, bone mineral density [BMD]). Methods: This prospective analysis included 161 806 postmenopausal women 50 to 79 years old, without history of hip fracture, enrolled in the Women's Health Initiative (WHI) Observational Study and Clinical Trials with a mean (SD) follow-up of 7.8 (1.6) years. Analyses were conducted for 130 487 women with complete information. Medication information was taken directly from drug containers during in-person interviews (baseline, year 3). The main outcome measures were self-reported fractures (hip [adjudicated], clinical spine, forearm or wrist, and total fractures) and for a subsample (3 densitometry sites), 3-year change in BMD. Results: During 1 005 126 person-years of follow-up, 1500 hip fractures, 4881 forearm or wrist fractures, 2315 clinical spine fractures, and 21 247 total fractures occurred. The multivariate-adjusted hazard ratios for current PPI use were 1.00 (95% confidence interval [CI], 0.71-1.40) for hip fracture, 1.47 (95% CI, 1.18-1.82) for clinical spine fracture, 1.26 (95% CI, 1.05-1.51) for forearm or wrist fracture, and 1.25 (95% CI, 1.15-1.36) for total fractures. The BMD measurements did not vary between PPI users and nonusers at baseline. Use of PPIs was associated with only a marginal effect on 3-year BMD change at the hip (P=.05) but not at other sites. Conclusion: Use of PPIs was not associated with hip fractures but wasmodestly associated with clinical spine, forearm or wrist, and total fractures.

AB - Background: Proton pump inhibitor (PPI) medications have been inconsistently shown to be associated with osteoporotic fractures. We examined the association of PPI usewith bone outcomes (fracture, bone mineral density [BMD]). Methods: This prospective analysis included 161 806 postmenopausal women 50 to 79 years old, without history of hip fracture, enrolled in the Women's Health Initiative (WHI) Observational Study and Clinical Trials with a mean (SD) follow-up of 7.8 (1.6) years. Analyses were conducted for 130 487 women with complete information. Medication information was taken directly from drug containers during in-person interviews (baseline, year 3). The main outcome measures were self-reported fractures (hip [adjudicated], clinical spine, forearm or wrist, and total fractures) and for a subsample (3 densitometry sites), 3-year change in BMD. Results: During 1 005 126 person-years of follow-up, 1500 hip fractures, 4881 forearm or wrist fractures, 2315 clinical spine fractures, and 21 247 total fractures occurred. The multivariate-adjusted hazard ratios for current PPI use were 1.00 (95% confidence interval [CI], 0.71-1.40) for hip fracture, 1.47 (95% CI, 1.18-1.82) for clinical spine fracture, 1.26 (95% CI, 1.05-1.51) for forearm or wrist fracture, and 1.25 (95% CI, 1.15-1.36) for total fractures. The BMD measurements did not vary between PPI users and nonusers at baseline. Use of PPIs was associated with only a marginal effect on 3-year BMD change at the hip (P=.05) but not at other sites. Conclusion: Use of PPIs was not associated with hip fractures but wasmodestly associated with clinical spine, forearm or wrist, and total fractures.

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