ASN's Mission

ASN leads the fight to prevent, treat, and cure kidney diseases throughout the world by educating health professionals and scientists, advancing research and innovation, communicating new knowledge, and advocating for the highest quality care for patients.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005


The Latest on Twitter

Kidney Week

Abstract: TH-PO586

Proton Pump Inhibitor Use and Risk of Major Fractures in Kidney Transplant Recipients

Session Information

Category: Bone and Mineral Metabolism

  • 402 Bone and Mineral Metabolism: Clinical


  • Lyu, Beini, University of Wisconsin-Madison, MADISON, Wisconsin, United States
  • Jorgenson, Margaret R., UW Health, Madison, Wisconsin, United States
  • Hansen, Karen, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States
  • Djamali, Arjang, University of Wisconsin, Madison, Wisconsin, United States
  • Astor, Brad C., University of Wisconsin, Madison, Wisconsin, United States

Fracture is a significant problem among kidney transplant recipients (KTRs). Proton pump inhibitors (PPIs) are among the most commonly prescribed drugs in KTRs and have been associated with a higher risk of fractures in the general population. This study aimed to determine how PPIs use is associated with the incidence of major fractures in KTRs.


Using the Wisconsin Allograft Recipient Database (WisARD), we identified 155 major fracture events that occurred at least 12 months after transplantation between 2000 and 2015. Each eligible case was matched using incidence density sampling with five controls on age, sex, race, transplantation year (±3 years), living versus deceased donor and prior transplantation. PPI and histamine 2-receptor antagonists (H2RA) use during the year prior to the index date were identified. The association between prior PPI/H2RA use and incidence of major fractures were assessed by conditional logistic regression.


A total of 155 cases were matched to 685 controls. A higher proportion of cases had a history of diabetes and cardiovascular disease. During the year prior to the index date, cases had lower serum albumin, higher phosphorus, higher iPTH, and higher alkaline phosphatase. A higher proportion of cases ever used corticosteroid and bisphosphonate.
67.7% of cases and 51.5% of controls ever used a PPI, and 15.5% of cases and 11.3% of controls ever used an H2RA. PPI use was associated with higher incidence of major fractures in unadjusted analysis (OR=2.4, 95% CI: 1.6-3.5). The association remained similar when adjusting for demographic and transplant-related covariates (OR=2.3, 95% CI: 1.5-3.6); and further adjusting for use of corticosteroid, bisphosphonate, vitamin D and calcium supplement (OR=1.9, 95% CI: 1.2-3.1). H2RA use was not associated with higher incidence of major fractures in adjusted analysis (OR=1.0, 95% CI: 0.5-1.8). The associations between PPI use and major fractures remain similar in participants who never used a bisphosphonate in the prior year.


PPI use may be associated with a higher risk of major fractures among KTRs. Clinicians should carefully evaluate the risk factors for fracture, weight the risk versus benefit before prescribing PPI, and have interval assessment of continued PPI use in KTRs.