Proton pump inhibitor (PPI) use is associated with an increased risk of hip fracture among patients on hemodialysis (HD), according to a new study.

“This investigation confirms needed vigilance for unnecessary long-term PPI use,” concluded a team led by Chandan Vangala, MD, of the Baylor College of Medicine in Houston.

Using the US Renal Data System, Dr Vangala and colleagues identified 4551 patients on HD who had experienced hip fractures from 2009 to 2014. They compared these patients with 45,510 controls matched by index date (date of hip fracture).

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PPI use in the 3 years preceding a hip fracture was associated with significant 19% increased odds of hip fracture, in adjusted analyses, the investigators reported online ahead of print in the Clinical Journal of the American Society of Nephrology. The study found no statistically significant association between hip fracture and use of histamine-2 receptor antagonists.

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“The lack of an association with prior histamine-2 receptor antagonist use and the study patients’ hemodialysis-dependent status may suggest a more direct influence of PPIs on bone quality, as opposed to an effect on cation and nutrient stores,” Dr Vangala’s team concluded. “Thus, we recommend interval assessment of continued PPI use in patients dependent on hemodialysis who already experience substantial medication burden.”


Vangala C, Niu J, Lenihan CR, et al. Proton pump inhibitors, histamine-2 receptor antagonists, and hip fracture risk among patients on hemodialysis. Clin J Am Soc Nephrol. 2018; published online ahead of print.