Older adults with autoimmune diseases at increased fracture risk when using PPIs, steroids

Proton pump inhibitors (PPIs) are linked to heightened risk of fractures among older adults with autoimmune rheumatic and gastrointestinal diseases, especially when PPIs are used in conjunction with glucocorticoids, according to a study.

Researchers looked at demographic information, diagnostic and procedural data, medication details, laboratory results, genomic information, and healthcare utilization metrics from 61 healthcare organizations from the TriNetX US collaborative database. They compared fracture risks associated with PPIs and H2 receptor antagonists (H2RAs) in adults who had autoimmune rheumatic and gastrointestinal diseases.

The study included 1,717,598 individuals. Propensity-score matching was performed with respect to demographic and clinical variables. This resulted in the inclusion of 16,299 new users of PPIs and 16,299 H2RA users for analysis.

Over a follow-up period of 24 months, fracture risks did not significantly differ between the PPI and H2RA users in the overall cohort (hazard ratio [HR], 1.369, 95 percent confidence interval [CI], 0.933–2.009).

However, subgroup analysis showed that among adults who were at least 65 years of age, PPI users had a significantly higher risk of fractures compared with H2RA users (HR, 1.927, 95 percent CI, 1.153–3.221). This association was stronger for nonvertebral fractures (HR, 2.379, 95 percent CI, 1.214–4.661),

Finally, the concurrent use of PPIs and glucocorticoids further increased the risk of fractures (HR, 4.273, 95 percent CI, 2.219–8.227).