The Korean journal of internal medicine

The Korean Association of Internal Medicine (대한내과학회)
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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

  • Dong Jun Oh (Department of Internal Medicine, Dongguk University Ilsan Hospital) ;
  • Ji Hyung Nam (Department of Internal Medicine, Dongguk University Ilsan Hospital) ;
  • Hyun Seok Lee (Department of Internal Medicine, Kyungpook National University Hospital) ;
  • Yeo Rae Moon (Data Platform Division, KakaoHealthcare Corp.) ;
  • Yun Jeong Lim (Department of Internal Medicine, Dongguk University Ilsan Hospital)
  • Received : 2023.08.05
  • Accepted : 2023.12.04
  • Published : 2024.03.01
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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: hazard ratio [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.

Keywords

Acknowledgement

The authors thank Hyun Jung Ahn for technical assistance for this study.

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