title: Use of proton pump inhibitors and mortality after hip fracture in a nationwide study.
abstract: We analyzed the association of proton pump inhibitors (PPIs) with mortality after osteoporosis-related hip fracture in Austria. PPIs were associated with reduced 90-day mortality but elevated mortality after half a year when initiated pre-fracture. Inpatients and discharged patients on PPIs showed lowered in-hospital and 90-day mortality, respectively.
  
  
  
  We herein investigated use of proton pump inhibitors (PPIs) and mortality among hip fracture patients in a nationwide study in Austria.
  
  
  
  In this retrospective cohort study, data on use of PPIs were obtained from 31,668 Austrian patients ≥50 years with a hip fracture between July 2008 and December 2010. All-cause mortality in patients without anti-osteoporotic drug treatment who had received their first recorded PPI prescription in the study period either before or after fracture was compared with hip fracture patients on neither PPIs nor anti-osteoporotic medication using logistic and Cox regression analysis.
  
  
  
  With PPI use, 90-day mortality was significantly reduced, both at initiation before (OR 0.66; p < 0.0001) and after hip fracture (OR 0.23; p < 0.0001). 90-day mortality was also reduced when PPIs were prescribed not until after discharge from the last recorded hip fracture-related hospital stay (OR 0.49; p < 0.0001) except for patients aged <70 years. In a sub-cohort of patients beginning PPIs during hospital stay, in-hospital mortality (0.2%) was substantially reduced relative to matched control patients (3.5%) (p < 0.0001). Longer-term mortality significantly increased after half a year post-fracture only among those who started PPI prescription before fracture.
  
  
  
  PPI use during and after hospital stay due to hip fracture is associated with a considerable decrease in mortality. These findings could have implications for hip fracture treatment.
authors.affiliation: Ludwig Boltzmann Institute of Osteology, Hanusch Hospital of the WGKK and AUVA Trauma Center, 1st Medical Department at Hanusch Hospital, Heinrich Collin Str. 30, 1140, Vienna, Austria. wolfgang.brozek@osteologie.at.
authors.forename: W
authors.identifier: 0000-0002-3626-9816
authors.initials: W
authors.lastname: Brozek
authors.affiliation: Sickness Fund Burgenland, Burgenländische Gebietskrankenkasse, Esterhazyplatz 3, 7000, Eisenstadt, Austria.
authors.forename: B
authors.initials: B
authors.lastname: Reichardt
authors.affiliation: Ludwig Boltzmann Institute of Osteology, Hanusch Hospital of the WGKK and AUVA Trauma Center, 1st Medical Department at Hanusch Hospital, Heinrich Collin Str. 30, 1140, Vienna, Austria.
authors.forename: J
authors.initials: J
authors.lastname: Zwerina
authors.affiliation: Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria.
authors.forename: H P
authors.initials: HP
authors.lastname: Dimai
authors.affiliation: Ludwig Boltzmann Institute of Osteology, Hanusch Hospital of the WGKK and AUVA Trauma Center, 1st Medical Department at Hanusch Hospital, Heinrich Collin Str. 30, 1140, Vienna, Austria.
authors.forename: K
authors.initials: K
authors.lastname: Klaushofer
authors.affiliation: Ludwig Boltzmann Institute of Osteology, Hanusch Hospital of the WGKK and AUVA Trauma Center, 1st Medical Department at Hanusch Hospital, Heinrich Collin Str. 30, 1140, Vienna, Austria.
authors.forename: E
authors.initials: E
authors.lastname: Zwettler
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001317:Austria / Q000453:epidemiology; D004334:Drug Administration Schedule; D004363:Drug Utilization / Q000706:statistics & numerical data; D005260:Female; D006620:Hip Fractures / Q000401:mortality*; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D058866:Osteoporotic Fractures / Q000401:mortality*; D054328:Proton Pump Inhibitors / Q000008:administration & dosage*; D012189:Retrospective Studies
chemical_list: D054328:Proton Pump Inhibitors
keywords: Epidemiology; Hip fracture; In-hospital; Mortality; Osteoporosis; Proton pump inhibitors