Proton Pump Inhibitor Use and Risk of Hip Fracture in Kidney Transplant Recipients

Colin R. Lenihan, Sumi Sukumaran Nair, Chandan Vangala, Venkat Ramanathan, Maria E. Montez-Rath, Wolfgang C. Winkelmayer

Research output: Contribution to journalArticlepeer-review

19 Scopus citations


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. Study Design A case-control study. Setting & Participants 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. Predictor PPI use. Outcomes 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. Limitations 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.

Original languageEnglish (US)
Pages (from-to)595-601
Number of pages7
JournalAmerican Journal of Kidney Diseases
Issue number5
StatePublished - May 2017


  • 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

ASJC Scopus subject areas

  • Nephrology


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