Fusaro M, D'Arrigo G, Pitino A, et al. - In a large international cohort of hemodialysis patients, researchers determined if proton pump inhibitors (PPIs) use was correlated with bone fractures (ie, hip fractures and fractures other than hip fractures). It included an observational prospective cohort of 27,097 patients with hemodialysis from the DOPPS study, 13,283 of whom were treated with PPIs. In multiple Cox models, the incidence rate of bone and hip fractures was significantly higher in PPI treated than in untreated PPI patients, taking into account the competitive risk of mortality. Such results were also true for numerous, cause-specific, hazards Cox models matching patients by dosage time. PPIs use needs caution and a careful assessment of risks/benefits ratio in patients with hemodialysis.