Use of proton pump inhibitors (PPIs) by patients on hemodialysis (HD) puts them at increased risk of bone fractures, a new study suggests.

PPI users had a significant 35% increased risk for hip fractures and 22% increased risk for fractures other than those of the hip in multiple Cox models that considered the competitive risk of mortality, Maria Fusaro, MD, PhD, of the Institute of Clinical Physiology in Pisa and the University of Padua in Italy, and colleagues reported in the Journal of Bone and Mineral Research.

“Considering the major health and economic burden of bone fractures, it is of utmost importance to adopt strategies for bone fractures prevention in a fragile population such as hemodialysis patients,” the authors wrote.

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The study included 27,097 HD patients in the Dialysis Outcomes and Practice Patterns Study (DOPPS). Of these, 13,283 (49%) were taking PPIs. Patients had a mean age of 63.9 years and mean dialysis vintage of 24 months. Over a median follow-up period of 19 months, 528 patients experienced hip fractures, 1592 patients experienced bone fractures other than hip fractures, and 6249 patients died. The mortality rate was significantly higher in PPI users than nonusers (25.8% vs 20.4%).

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The new study builds on previous research showing a link between PPI use and fracture risk among HD patients. In a study of HD patients in the US Renal Data System, a team led by Chandan Vangala, MD, of the Baylor College of Medicine in Houston, found that PPI use in the 3 years preceding a hip fracture was associated with significant 19% increased odds of hip fracture, in adjusted analyses, according to results published in the Clinical Journal of the American Society of Nephrology. The study compared 4551 patients who experienced hip fractures (cases) and 45,510 who did not (controls).


Fusaro M, D’Arrigo G, Pitino A, et al. Increased risk of bone fractures in hemodialysis patients treated with proton pump inhibitors in real world: results from the Dialysis Outcomes and Practice Patterns Study (DOPPS). J Bone Miner Res. 2019;  doi: 10.1002/jbmr.3842

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;13:1534-1541. doi: 10.2215/CJN.02190218