林俊哲Chun-Che Lin蔡佳勳Chia-Hsun Tsai醫學研究所2026-10-299999-12-312017https://handle.ncl.edu.tw/11296/nbxp29https://scholars.csmu.edu.tw/handle/123456789/36334目的 :糖尿病是國人十大死因之一，全國約有200多萬名糖尿病的患者，糖尿病及其所引發的併發症對於患者健康有重大影響，骨折也是其中的併發症之一，不但影響患者的日常生活也增加死亡率。氫離子幫浦抑制劑是一種治療胃食道逆流和胃及十二指腸潰瘍的重要藥物，過去有研究指出長期使用質子幫浦抑制劑會增加骨折的風險。本研究的目的在於探討在糖尿病的患者上，使用氫離子幫浦抑制劑是否會增加骨折的風險。方法及結果 : 本研究為使用健保資料庫的回溯性研究，從西元2002年1月至2013年12月新診斷的糖尿病患者總共30324患者，排除癌症和在診斷糖尿病前有使用氫離子幫浦抑制劑和骨折的患者，總共有30324糖尿病患者使用氫離子幫浦抑制劑納入分析，進一步採用1:4配對，分成有使用和無使用氫離子幫浦抑制劑兩組，比較這兩組糖尿病患者的骨折發生率。使用氫離子幫浦抑制劑的患者總共有1547個骨折事件發生(5.1%)，未使用氫離子幫浦抑制劑的患者則有5657個骨折事件發生(4.7%)，有使用氫離子幫浦抑制劑的患者有明顯較高的骨折發生(P=0.001)，在多變項分析中可以看到使用氫離子幫浦抑制劑的患者，發生骨折的風險提高(hazard ratio=1.39 , 95% CI = 1.32–1.48)，而在使用氫離子幫浦抑制劑超過1年的患者有更顯著的骨折發生率( hazard ratio =1.65,1.39-1.95,95% confidence interval)，在進一步分成長骨、非長骨和髖部骨折分析，仍可以看到骨折風險提高(hazard ratios: 1.35, 95% CI = 1.26-1.45；1.47, 95% CI =1.35-1.61；1.77, 95% CI =1.56-2.01)結論: 本研究指出使用氫離子幫浦抑制劑在糖尿病的患者可能會增加骨折的風險，因此長時間的使用氫離子幫浦抑制劑於糖尿病患者須審慎評估風險。Introduction: Type 2 diabetes mellitus is a metabolic disease characterized by hyperglycemia, insulin resistance, and impairment in insulin secretion. It is a common disease in the world and has risen in the past decade. Type 2 diabetes mellitus is associated with an increased risk of osteoporotic fractures, resulting in disabilities and increased mortality. Proton-pump inhibitors (PPIs) are a group of acid-suppressive drugs which is used in treatment for gastroesophageal reflux and peptic ulcer disease worldwide. Although PPIs are generally well accepted with little side effect, but some observational studies have reported the association between PPI therapy and the risk of fracture. PPI therapy and the risk of fracture in diabetic patients need to be elucidated.Purpose: To explore the association between PPI therapy and the risk of fracture in diabetic patientsMethod: In this retrospective cohort study, we used data from the Longitudinal Cohort of Diabetes Patients (LHDB 2002) . Total 30324 Patients who diagnosis type 2 diabetes mellitus between 1 January 2002 and 31 December 2013 were recruited for this study. Patient with malignancy, previously used PPI, or ever suffered bone fracture before index data were excluded. Fracture events during the years from 2002 to 2013 were collected to calculate the cumulative rate of fracture in PPI and non-PPI group.Result:A total of 30324 patients and 121296 controls were enrolled in the study. Our study shows that the cumulative incidence of fracture was higher in the PPI use cohort than the non-PPI use cohort (P = 0.001). In multivariate analysis , the adjusted HRs of fracture were 1.39 in PPI cohort relative to the non-PPI cohort (95% CI = 1.32–1.48). There is significantly increased risk of bone fracture if use of PPI is prolonged over one year (aHR : 1.65, 95% CI = 1.39–1.95). We further analysis with bootstrap sensitivity analysis , and PPI cohort also have significantly increased risk for fracture (total fracture : aHR = 1.24, 95% CI = 1.28–1.43 , long bone fracture :aHR = 1.27, 95% CI =1.18-1.37, non-long bone fracture : aHR = 1.48, 95% CI = 1.35–1.62 , and hip fracture : aHR = 1.71, 95% CI = 1.5–1.96).Conclusion:PPI use was associated with fracture in diabetic adults and prolonged use of PPI could increase the risk of fracture. Patient with type 2 DM who use PPIs should be cautioned regarding increased risk for fracture氫離子幫浦抑制劑糖尿病骨折Proton-pump inhibitorsDiabetes mellitusfracturethesis