The influence of proton pump inhibitors (PPIs) on the risk of osteoporotic fractures remains to be elucidated, especially in the Asian population. This study evaluated the risk of osteoporotic fractures in elderly female Korean PPI users compared to histamine-2 receptor antagonist (H2RA) users, as well as the relationship between fractures and the duration, dose, and pattern of use of PPI. We screened a nationwide cohort of elderly Korean women who underwent bone mineral density measurements during their 66-year-old life-transition medical examination between 2009 and 2014. Study subjects included 8903 cases diagnosed with new osteoporotic fractures and 44,515 matched controls (1:5 ratio based on cohort entry date, follow-up duration, and baseline osteoporosis status) without fractures. They were followed up until 2015. Information on the exposure to PPI or H2RA, occurrence of fracture, and covariates were obtained from the Korean National Health Insurance Service data. Covariate-adjusted odds ratio (aOR) and 95% confidence interval (CI) were estimated using conditional logistic regression analysis. PPI use was associated with an increased risk of osteoporotic fractures (aOR: 1.13, 95% CI: 1.07, 1.18) compared with H2RA-only use. Increasing duration of PPI use was positively associated with the risk of osteoporotic fracture [aOR (95% CI) of long-term PPI use (≥1 year): 1.3 (1.09, 1.56)]. Recent PPI use within the last year was associated with an increased risk of fracture (aOR: 1.31, 95% CI: 1.23, 1.38), whereas remote PPI use was not (aOR: 0.98, 95% CI: 0.92, 1.04). The risk of fracture did not increase with the increasing cumulative PPI dose. Compared with the use of H2RA alone, PPI use was associated with an increased risk of osteoporotic fractures in elderly Korean women, particularly among those who had used PPI within the last year or for more than one year.

中文翻译：

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老年女性使用质子泵抑制剂和组胺 2 受体拮抗剂治疗骨质疏松性骨折风险的比较分析：一项全国性基于人群的巢式病例对照研究

质子泵抑制剂 (PPI) 对骨质疏松性骨折风险的影响仍有待阐明，尤其是在亚洲人群中。本研究评估了与组胺 2 受体拮抗剂 (H2RA) 使用者相比，韩国老年女性 PPI 使用者发生骨质疏松性骨折的风险，以及骨折与 PPI 的持续时间、剂量和使用模式之间的关系。我们筛选了一个全国性的韩国老年女性队列，这些女性在 2009 年至 2014 年期间在 66 岁的生命过渡期体检期间接受了骨矿物质密度测量。研究对象包括 8903 名诊断为新发骨质疏松性骨折的病例和 44,515 名匹配的对照（1:5比率基于队列进入日期、随访持续时间和基线骨质疏松症状态）没有骨折。他们被跟踪到2015年。有关 PPI 或 H2RA 暴露、骨折发生和协变量的信息来自韩国国民健康保险服务数据。使用条件逻辑回归分析估计协变量调整的优势比 (aOR) 和 95% 置信区间 (CI)。与仅使用 H2RA 相比，使用 PPI 与骨质疏松性骨折风险增加有关（aOR：1.13，95% CI：1.07，1.18）。PPI 使用时间的延长与骨质疏松性骨折的风险呈正相关 [长期 PPI 使用（≥1 年）的 aOR (95% CI)：1.3 (1.09, 1.56)]。最近一年内使用 PPI 与骨折风险增加相关（aOR：1.31，95% CI：1.23，1.38），而远程 PPI 使用则没有（aOR：0.98，95% CI：0.92，1.04）。骨折风险并未随着累积 PPI 剂量的增加而增加。