title: Proton Pump Inhibitor Use and Risk of Hip Fracture in Kidney Transplant Recipients.
abstract: BACKGROUND
  Posttransplantation bone disease is a significant problem, with few well-evidenced therapeutic options. Proton pump inhibitors (PPIs) are associated with hip fracture in the general population and are widely prescribed for kidney transplant recipients.
  
  
  METHODS
  A case-control study.
  
  
  METHODS
  From the US Renal Data System, we identified from diagnoses and procedures 231 kidney transplant recipients with a first hip fracture. Cases were matched at the hip fracture index date with 15,575 controls on age, sex, race, and transplantation year.
  
  
  METHODS
  PPI use.
  
  
  RESULTS
  First hip fracture.
  
  
  RESULTS
  In the year prior to the index date, a PPI was prescribed to 65.4% of cases and 57.4% of controls. Additionally, in 34.6% of cases and 28.9% of controls, a PPI was prescribed for >80% of the year preceding the index date (higher PPI users). Unadjusted ORs of hip fracture associated with any and higher PPI use were 1.55 (95% CI, 1.18-2.05) and 1.65 (95% CI, 1.2-2.27), respectively. When adjusted for baseline demographic, clinical, and pharmacologic covariables, any and higher PPI use remained associated with hip fracture, with ORs of 1.39 (95% CI, 1.04-1.84) and 1.41 (95% CI, 1.02-1.95), respectively.
  
  
  CONCLUSIONS
  Potential residual confounding through either incorrectly ascertained or unavailable confounders; cohort limited to Medicare beneficiaries receiving low-income subsidy.
  
  
  CONCLUSIONS
  In summary, PPI use was associated with hip fracture risk in the US kidney transplant population.
authors.affiliation: Stanford University School of Medicine, Palo Alto, CA. Electronic address: clenihan@stanford.edu.
authors.forename: Colin R
authors.initials: CR
authors.lastname: Lenihan
authors.affiliation: Mayo Clinic Arizona, Scottsdale, AZ.
authors.forename: Sumi
authors.initials: S
authors.lastname: Sukumaran Nair
authors.affiliation: Baylor College of Medicine, Houston, TX.
authors.forename: Chandan
authors.initials: C
authors.lastname: Vangala
authors.affiliation: Baylor College of Medicine, Houston, TX.
authors.forename: Venkat
authors.initials: V
authors.lastname: Ramanathan
authors.affiliation: Stanford University School of Medicine, Palo Alto, CA.
authors.forename: Maria E
authors.initials: ME
authors.lastname: Montez-Rath
authors.affiliation: Baylor College of Medicine, Houston, TX.
authors.forename: Wolfgang C
authors.initials: WC
authors.lastname: Winkelmayer
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D016208:Databases, Factual; D005260:Female; D006620:Hip Fractures / Q000453:epidemiology*; D006801:Humans; D016030:Kidney Transplantation; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D054328:Proton Pump Inhibitors / Q000627:therapeutic use*; D012307:Risk Factors; D014481:United States / Q000453:epidemiology
chemical_list: D054328:Proton Pump Inhibitors
keywords: Proton pump inhibitor (PPI); US Renal Data System (USRDS); bone disease; case-control; drug safety; end-stage renal disease (ESRD); hip fracture; kidney transplantation; modifiable risk factor; omeprazole; outcomes; peptic ulcer prophylaxis; renal transplant recipient