Incidence and predictors of osteoporotic fractures in patients with Barrett's oesophagus: a population‐based nested case‐control study

Abstract

Summary BACKGROUND Proton pump inhibitors (PPI) are inconsistently associated with osteoporotic fractures. Barrett’s oesophagus patients are treated with high PPI doses for prolonged periods, but there is limited data on the incidence of osteoporosis and fractures in them. AIM In this study, we aimed to estimate the incidence of (and risk factors for) low bone mass (osteoporosis and/or osteopenia) related fractures in a population-based Barrett’s oesophagus cohort. METHODS All subjects with Barrett’s oesophagus and a diagnosis of osteoporosis and fractures were identified using Rochester Epidemiology Project (REP) resources. The incidence rates of all and osteoporotic fractures in these subjects were compared to an age- and gender similar population in Olmsted County to determine standardized incidence ratios (SIR). Predictors were assessed using Cox proportional hazards models. RESULTS Five hundred and twenty-one patients were included [median (IQR) age 61(52, 72) years; three hundred ninety-eight (76%) men] of whom one hundred thirteen (21.7%) had fractures, and forty-six (8.8%) had osteoporotic fractures. The incidence of all fractures and osteoporotic fractures was comparable to that of an age- and gender- matched population (SIR 1.09; 95% CI 0.92–1.29: SIR 1.05; 95% CI 0.85–1.29). PPI use, dose or duration of use was not associated with osteoporotic fracture risk (HR 0.87; 95% CI 0.12–6.39). Independent risk factors for osteoporotic fractures included older age, female gender and higher co-morbidity index. CONCLUSIONS The incidence of osteoporotic fractures was not increased in Barrett’s oesophagus patients compared to the general population. Additionally, PPI use was not associated with increased fracture risk regardless of the duration of therapy or dose.

Helicobacter pylori Related Diseases and Osteoporotic Fractures (Narrative Review)

“…Several studies reported an association between GERD and vertebral fractures or kyphosis [ 256 , 257 , 258 ]. The most recent publications, however, did not confirm that GERD and decreased BMD are linked [ 117 ], neither that the incidence of OFs is higher among subjects with BO [ 259 ] (Kumar S 2017). As in the total population, older age, female gender and a higher comorbidity index were the independent risk factors for OFs in patients with BO.…”

Letter: association between proton pump inhibitor use and fracture risk ‐ causality or confounding?

“…If PPIs have any effects on bone, they are likely to be systemic. 4 Other fractures among the study population were not reported. The negative results reported do not necessarily mean that there was no association between PPI use and other fractures.…”

Proton pump inhibitor use and risk of hip fractures among community‐dwelling persons with Alzheimer's disease—a nested case‐control study

“…Several previous studies have found association between PPI use and an increased risk of hip fracture [12][13][14][15][16] but there are also studies which did not find an association. [17][18][19] According to a novel meta-analysis, the risk seems to be modestly increased (RR = 1.26; 95% CI 1. 16-1.36), albeit the studies are heterogeneous.…”