PPI use in type 2 diabetes may exacerbate hip fracture risk

Type 2 diabetes mellitus (T2DM) patients taking proton pump inhibitors (PPIs) are at a higher risk of sustaining hip fractures, a recent study has found.

The retrospective, population-based analysis included 398,885 T2DM patients. After propensity score matching, 44,431 PPI users (mean age, 59.23±12.56 years; 57.2 percent male) were included in the analysis and compared to 177,364 non-users (mean age, 58.95±12.71 years; 57.2 percent male). The primary outcome was the development of hip fractures.

Over the follow-up period, 683 cases of hip fractures occurred in the PPI group, corresponding to an incidence rate of 1.54 percent. In comparison, 1,808 such episodes were reported in the non-PPI comparators, with a rate of 1.02 percent.

Cox proportional hazards regression models found that the use of PPIs significantly increased the risk of sustaining hip fractures (hazard ratio [HR], 1.41, 95 percent confidence interval [CI], 1.29–1.54; p<0.001). The statistical model was adjusted for comorbidities and medications. Sex also appeared to be an important factor, such that males saw a lower hip fracture risk than females (HR, 0.65, 95 percent CI, 0.60–0.70; p<0.001).

The researchers then grouped the PPI patients according to their defined daily dose (DDD): nonuse (<28 DDD; n=177,364), 28–65 DDD (n=14,985), 66–124 DDD (n=14,608), and >125 DDD (n=14,748). Compared with the lowest category of cumulative dose of PPI, all other DDDs conferred a higher risk of hip fractures, though without a trend indicative of a dose-response relationship.