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KMID : 0338420240390020228
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The Korean Journal of Internal Medicine
2024 Volume.39 No. 2 p.228 ~ p.237
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The combined use of anti-peptic agents is associated with an increased risk of osteoporotic fracture: a nationwide case-control study
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Oh Dong-Jun
Nam Ji-Hyung
Lee Hyun-Seok
Moon Yeo-Rae
Lim Yun-Jeong
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Abstract
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Background/Aims: Long-term use of acid suppressants such as proton pump inhibitors (PPIs) and histamine 2 receptor antagonist (H2RA) has been associated with the risk of osteoporotic fracture. Acid suppressants and muco-protective agents (MPAs) are often used together as anti-ulcer agents. We evaluated the association between the risk of osteoporotic fracture and the combined use of these anti-peptic agents.
Methods: A population-based case-control study was conducted by analyzing the Korean National Health Insurance Data from 2014 to 2020. Patients who had been prescribed anti-peptic agents, such as PPI, H2RA, or MPA, were included. Considering the incidence of osteoporotic fractures, the case group (n = 14,704) and control group (n = 58,816) were classified by 1:4 matching based on age and sex.
Results: The use of all types of anti-peptic agents was associated with an increased risk of osteoporotic fractures (PPI: hazardosteoratio [HR], 1.31; H2RA: HR, 1.44; and MPA: HR, 1.33; all p < 0.001). Compared to PPI alone, the combined use of “PPI and H2RA” (HR, 1.58; p = 0.010) as well as “PPI, H2RA, and MPA” (HR, 1.71; p = 0.001) was associated with an increased risk of osteoporotic fracture. However, compared with PPI alone, “MPA and PPI or H2RA” was not associated with an increased risk of osteoporotic fracture.
Conclusions: This study found that the combined use of “PPI and H2RA” was associated with a higher risk of osteoporotic fractures. In cases where deemed necessary, the physicians may initially consider prescribing the combination use of MPA.
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KEYWORD
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Anti-ulcer agents, Proton pump inhibitor, Histamine H2 antagonists, Osteoporotic fracture
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