The combined use of anti-peptic agents is associated with an increased risk of osteoporotic fracture: a nationwide case-control study
4
조회
0
다운로드
1
인용
0
참고문헌
키워드
초록
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.
Abstract
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.
참고문헌 (31)
- Barnett K, "Epidemiology of multimorbidity and implications for health care, research, and medical education : a cross-sectional study", Lancet, 380, pp.37~43 (2012)
- McLean AJ, "Aging biology and geriatric clinical pharmacology", Pharmacol Rev, 56, pp.163~184 (2004)
- Targownik LE, "AGA clinical practice update on de-prescribing of proton pump inhibitors : expert review", Gastroenterology, 162, pp.1334~1342 (2022)
- Lanza FL, "Guidelines for prevention of NSAID-related ulcer complications", Am J Gastroenterol, 104, pp.728~738 (2009)
- Clarke K, "Indications for the use of proton pump inhibitors for stress ulcer prophylaxis and peptic ulcer bleeding in hospitalized patients", Am J Med, 135, pp.313~317 (2022)
- Lanas A, "Peptic ulcer disease", Lancet, 390, pp.613~624 (2017)
- Richter JE, "Presentation and epidemiology of gastroesophageal reflux disease", Gastroenterology, 154, pp.267~276 (2018)
- Talley NJ, "Functional dyspepsia", Curr Opin Gastroenterol, 32, pp.467~473 (2016)
- Lei WY, "Predicting factors of recurrence in patients with gastroesophageal reflux disease : a prospective follow-up analysis", Therap Adv Gastroenterol, 12, pp.1756284819864549~ (2019)
- Black CJ, "Functional gastrointestinal disorders : advances in understanding and management", Lancet, 396, pp.1664~1674 (2020)
- Yang YX, "Long-term proton pump inhibitor therapy and risk of hip fracture", JAMA, 296, pp.2947~2953 (2006)
- Targownik LE, "Use of proton pump inhibitors and risk of osteoporosis-related fractures", CMAJ, 179, pp.319~326 (2008)
- Park JH, "Comparing proton pump inhibitors with histamin-2 receptor blockers regarding the risk of osteoporotic fractures : a nested case-control study of more than 350, 000 Korean patients with GERD and peptic ulcer disease", BMC Geriatr, 20, pp.407~ (2020)
- Yu SY, "Consumption of medicines used for gastric acid-related disorders in Australia and South Korea : a cross-country comparison", Eur J Clin Pharmacol, 76, pp.547~555 (2020)
- Park JH, "Comparative analysis of the risk of osteoporotic fractures with proton pump inhibitor use and histamine-2 receptor antagonist therapy in elderly women : a nationwide population-based nested case-control study", Bone, 135, pp.115306~ (2020)
- Charlson ME, "A new method of classifying prognostic comorbidity in longitudinal studies : development and validation", J Chronic Dis, 40, pp.373~383 (1987)
- "Osteoporosis: assessing the risk of fragility fracture" (2017), National Institute for Health and Care Excellence (NICE)
- NIH Consensus Development Panel on Osteoporosis Prevention, Diagnosis, and Therapy, "Osteoporosis prevention, diagnosis, and therapy", JAMA, 285, pp.785~795 (2001)
- Kanis JA, "Diagnosis of osteoporosis and assessment of fracture risk", Lancet, 359, pp.1929~1936 (2002)
- Watts NB, "Adverse bone effects of medications used to treat non-skeletal disorders", Osteoporos Int, 28, pp.2741~2746 (2017)
- Salvo EM, "Umbrella review of 42 systematic reviews with meta-analyses : the safety of proton pump inhibitors", Aliment Pharmacol Ther, 54, pp.129~143 (2021)
- Abtahi S, "Concomitant use of oral glucocorticoids and proton pump inhibitors and risk of osteoporotic fractures among patients with rheumatoid arthritis : a population-based cohort study", Ann Rheum Dis, 80, pp.423~431 (2021)
- Kim JJ, "Association between proton pump inhibitor use and risk of fracture : a population-based case-control study", PLoS One, 15, pp.e0235163~ (2020)
- "Stat. OECD Health Statistics 2022, Health Care Utilisation" (2022)[URL]
- Kim TJ, "Effectiveness of acid suppressants and other mucoprotective agents in reducing the risk of occult gastrointestinal bleeding in nonsteroidal anti-inflammatory drug users", Sci Rep, 9, pp.11696~ (2019)
- Kim GH, "Efficacy and safety of rebamipide versus its new formulation, AD-203, in patients with erosive gastritis : a randomized, double-blind, active control, noninferiority, multicenter, phase 3 study", Gut Liver, 15, pp.841~850 (2021)
- Ito T, "Association of long-term proton pump inhibitor therapy with bone fractures and effects on absorption of calcium, vitamin B12, iron, and magnesium", Curr Gastroenterol Rep, 12, pp.448~457 (2010)
- Ryoo SB, "The effects of eupatilin(stillen®)on motility of human lower gastrointestinal tracts", Korean J Physiol Pharmacol, 18, pp.383~390 (2014)
- Kim JY, "Massive elimination of multinucleated osteoclasts by eupatilin is due to dual inhibition of transcription and cytoskeletal rearrangement", Bone Rep, 3, pp.83~94 (2015)
- Nanke Y, "Rebamipide, an amino acid analog of 2(1H)-quinolinone, inhibits the formation of human osteoclasts", Biomed Res Int, 2016, pp.6824719~ (2016)
- Blackwell KA, "Prostaglandins in bone : bad cop, good cop?", Trends Endocrinol Metab, 21, pp.294~301 (2010)