PPIs Reduce Post-Hip Fracture Mortality Save

The association between the use of proton pump inhibitors (PPIs), osteoporosis (OP) and OP-related fragility fractures has been a topic of ongoing discussion in rheumatology community.

Multiple studies indicate direct association between PPI use and increased risk of osteoporosis and fragility fractures. It appears that the risk increases with therapy duration (1). It has been presumed that PPI use results in altered calcium absorption, leading to OP and fractures in some. However, studies assessing association between PPI use and post-fracture mortality rates were lacking to date.

A new nationwide Austrian cohort study was designed to assess effect of PPI use on mortality rate after osteoporosis related hip fracture. (Citation source: http://buff.ly/2jRAhYK)

The study evaluated 31,668 Austrian patients >50 years with a history of hip fracture between July 2008 and December 2010. Patents with a history of PPI use before or after fracture related hospitalization, their mortality cause and bone strengthening medication were compared to patients with no history of PPI or anti-osteoporosis medication use in Cox regression analysis. 

With PPI use, 90-day mortality was significantly reduced, both at initiation before (OR 0.66; p < 0.0001) and after hip fracture (OR 0.23; p < 0.0001).

90-day mortality was also reduced when PPIs were delayed until after discharge from the last recorded hip fracture-related hospital stay (OR 0.49; p < 0.0001) . Such outcomes were not observed in patients older than 70 years old.

This study also reported significant increase in long term mortality (6 months after post-fracture) in patients who started PPI before fracture. No such effect was observed in the group who started PPI during post-fracture hospitalization.

Overall, the study concluded that PPI use both before and after hip fracture is associated with significant decrease in post-fracture mortality.