Proton pump inhibitor use and the risk of osteoporosis and fracture in stroke patients: a population-based cohort study

Lin, Shu‐Man; Yang, Sung-Byung; Liang, Chung Chao; Huang, Huei‐Kai

doi:10.1007/s00198-017-4262-2

Cited by 47 publications

(32 citation statements)

References 43 publications

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“…Information on income level was retrieved as a representation of socioeconomic status. The monthly income level was divided into four groups (New Taiwan dollars ≥ 45,000; 30,000–44,999; 15,840–29,999; and financially dependent) based on the income-related NHI premiums as described in detail previously 34 .…”

Section: Methodsmentioning

confidence: 99%

Cataract and the increased risk of depression in general population: a 16-year nationwide population-based longitudinal study

Chen

Liu

Lin

et al. 2020

Sci Rep

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Cataract is the primary cause of visual impairment and can be corrected by cataract surgery. We investigated the impact of cataract on the risk of depression along with the benefits of cataract surgery. Patients newly diagnosed with cataract by ophthalmologists between 2001 and 2015 were identified from the National Health Insurance Research Database (NHIRD) in Taiwan. Non-cataract individuals were recruited by 1:1 matching for age, sex and index year. After propensity score matching, 233,258 patients in total were included in our study: 116,629 in each of the cataract and non-cataract cohorts. The primary outcome was the new diagnosis of depression by psychiatrists. In a mean follow-up period of 7.8 years, cataract was significantly associated with increased risk of developing depression (adjusted hazard ratio [aHR] = 1.78, 95% confidence interval [CI] 1.70–1.87, p < 0.001). We further divided the cataract cohort into surgery and non-surgery groups. Notably, cataract surgery group was associated with a decreased risk of depression compared with non-surgery patients (aHR = 0.75, 95% CI 0.71–0.79, p < 0.001). Our results emphasise the importance of regular screening for depression among cataract patients and the beneficial effect of cataract surgery in reducing the risk of depression.

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Section: Methodsmentioning

confidence: 99%

Cataract and the increased risk of depression in general population: a 16-year nationwide population-based longitudinal study

Chen

Liu

Lin

et al. 2020

Sci Rep

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“…Nevertheless, the list of potential side-effects related to long-term PPI use is increasing, including among others, chronic kidney disease, osteoporosis and fractures, Clostridium difficile infections, community acquired pneumonia, cardiac diseases, and even increased mortality [8][9][10][11][12][13][14][15][16][17][18][19]. An increasing number of studies have also investigated the risk of cancer with most evidence existing for gastric, colorectal and pancreatic cancer.…”

Section: Introductionmentioning

confidence: 99%

Long-term proton pump inhibitor usage and the association with pancreatic cancer in Sweden

2019

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Background The long-term safety of proton pump inhibitors (PPIs) is increasingly questioned. The aim of our study was to assess the risk of pancreatic cancer among longterm PPI users in Sweden. Methods This population-based nationwide Swedish cohort study including 796,492 adult long-term PPI users has been used to calculate the standardized incidence rate ratios (SIRs) and 95% confidence intervals (CI) for pancreatic cancer, stratifying by indications of use, age, sex, and duration of use. The risk among all 20,210 long-term H2-receptor antagonist users was assessed as comparison.Results Pancreatic cancer was found in 1733 long-term PPI users, and 25 H2-receptor antagonist users. For PPI users, the risk of pancreatic cancer was increased overall (SIRs = 2.22; 95% CI 2.12-2.32) and in all subgroup analyses, with the highest risk among PPI-users younger than 40 years (SIR = 8.90,, and among individuals with a history of Helicobacter pylori (SIR = 2.99, 95% CI 2.54-3.49). After the first year after enrolment (during which PPI use may be because of early symptoms of pancreatic cancer), the risk remained increased over time, with SIR = 1.57 (95% CI 1.38-1.76) after 5 years. No associations were found for H2-receptor antagonists (SIR = 1.02, 95% CI 0.66-1.51). Conclusions This large study showed an increased risk of pancreatic cancer in long-term users of PPIs in Sweden, in particular among the youngest users.

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“…Cumulative and average PPI doses >90 DDDs and >0.25 DDDs/day tended to entail elevated risk, however, average DDDs above 1.00/day were associated with a risk reduction compared with lower doses of 0.75–1.00/day. In support of a dose-response effect, Chiu et al (2010) identified the highest risk of hip fracture for >91 cumulative DDDs, and in stroke patients, cumulative DDDs >365 were associated with greater hip fracture risk than lower doses ( Lin et al, 2018 ). Similarly, Yang et al (2006) and de Vries et al (2009) reported the highest hip fracture risk at the highest average daily PPI doses.…”

Section: Discussionmentioning

confidence: 94%

Higher dose but not low dose proton pump inhibitors are associated with increased risk of subsequent hip fractures after first hip fracture: A nationwide observational cohort study

Brozek¹,

Reichardt

Zwerina³

et al. 2019

Bone Reports

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Aim To examine the association of proton pump inhibitor (PPI) use with subsequent hip fracture incidence in hip fracture patients, accounting for gender, age, PPI doses, PPI initiation before or after first fracture, and year from first fracture in which the first subsequent fracture occurred. Methods Data from 31,668 Austrian patients ≥50 years with the first hip fracture between July 2008 and December 2010 were analyzed retrospectively. After exclusion of patients on anti-osteoporotic medication, incidence of subsequent hip fractures was compared between users and non-users of PPIs using regression models. Results In general, use of PPIs among hip fracture patients was associated with increased risk for subsequent hip fracture (OR 1.58, 95%-CI 1.25–2.00), in particular in men, in the age group of 70–84 years, and when PPIs were initiated before the first fracture. Low PPI doses of ≤90 cumulative DDDs and ≤0.25 DDDs/day, however, were not linked to elevated subsequent fracture risk, especially among female patients. Subsequent hip fracture incidence was elevated within the first year after first fracture in female and male PPI users (OR 1.75, 95%-CI 1.28–2.38) and dropped in women but not in men in the second year. Conclusions Low-dose PPI use is not associated with increased risk of subsequent hip fractures, especially in women. Patients thus get most benefit of short-term PPI use after a hip fracture that has previously been linked to lowered mortality if low doses are not exceeded. Varying risk profiles for the time of subsequent hip fracture could have implications for risk group-specific follow-up care.

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Proton pump inhibitor use and the risk of osteoporosis and fracture in stroke patients: a population-based cohort study

Abstract: PPI use is associated with an increased risk of osteoporosis, hip fracture, and vertebral fracture in stroke patients.

Cited by 47 publications

References 43 publications

Cataract and the increased risk of depression in general population: a 16-year nationwide population-based longitudinal study

Cataract and the increased risk of depression in general population: a 16-year nationwide population-based longitudinal study

Long-term proton pump inhibitor usage and the association with pancreatic cancer in Sweden

Higher dose but not low dose proton pump inhibitors are associated with increased risk of subsequent hip fractures after first hip fracture: A nationwide observational cohort study

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