Effect of Chronic Use of Proton Pump Inhibitors on Bone Mineral Density
Iraqi Postgraduate Medical Journal,
2022, Volume 21, Issue 2, Pages 236-242
Proton pump inhibitors (PPIs) are widely used drugs for the treatment of many diseases. Prolonged use was believed to have an effect on bone mineral metabolism.
To investigate the effect of PPIs on bone mineral density and to identify risk factors affecting bone mineral density among users of PPIs.
PATIENTS AND METHODS:
A cross sectional study was conducted in Rheumatology Consultancy Clinic of Baghdad Teaching Hospital /Baghdad Medical City during the period from 1st of November, 2017 to 31st of October, 2018 on convenient sample of 100 patients were selected; first group was 50 PPI users and 50 PPI non-users. The bone mineral density of patients was assessed using dual energy x-ray absorptiometry (DXA) scan.
A significant reduction in serum calcium, vitamin D and serum inorganic phosphorus levels of PPIs users with elevated level of alkaline phosphatase activity. All scores of DXA scan like T-scores L2-L4, Z-scores L2-L4 and total scores were significantly reduced among PPIs users in comparison to PPIs-non users (P<0.05).
The proton pump inhibitors have a profound effect on bone mineral density and long term use of proton pump inhibitors is commonly related with osteoporosis and osteopenia development of lumbar spines.
- Yanagihara GR, de Paiva AG, Neto MP, Torres LH, Shimano AC, Louzada MJQ, et al. Effects of long-term administration of omeprazole on bone mineral density and the mechanical properties of the bone. Revista Brasileira de Ortopedia 2015; 50:232-38.
- Insogna KL. The effect of proton pump-inhibiting drugs on mineral metabolism. Am J Gastroenterol 2009; 104(Suppl 2):S2–S4.
- Lau AN, Tomizza M, Wong-Pack M, Papaioannou A, Adachi JD. The relationship between long-term proton pump inhibitor therapy and skeletal frailty. Endocrine 2015; 49:606-10.
- Targownik LE, Lix LM, Metge CJ, Prior HJ, Leung S, Leslie WD. Use of proton pump inhibitors and risk of osteoporosis-related fractures. CMAJ 2008; 179:319–26.
- O'Connell MB, Madden DM, Murray AM, Heaney RP, Kerzner LJ. Effects of proton pump inhibitors on calcium carbonate absorption in women: A randomized crossover trial. Am J Med 2005; 118:778–81.
- Yamasaki Y, Fujimura T, Oyama K, Higashi Y, Hirose A, Tsukada T, et al. Effects of rabeprazole on bone metabolic disorders in a gastrectomized rat model. Biomedical Reports 2016; 5:118-24.
- Couris RR, Dinsmore S, Grams M-K. Osteoporosis; In Zeind CS, Carvalho MG. Applied therapeutics: The clinical use of drugs. Wolters Kluwer, Philadelphia USA 2018:2269.
- Dial S. Use of gastric acid-suppressive agents and the risk of community acquired Clostridium difficile associated disease. JAMA 2005; 294:2989–95.
- Howell MD. Iatrogenic gastric acid suppression and the risk of nosocomial Clostridium difficile infection. Arch Intern Med 2010; 170:784–90.
10. Rozgony NR. Vitamin B (12) deficiency is linked with long-term use of proton pump inhibitors in institutionalized older adults: 79 could a cyanocobalamin nasal spray be beneficial? J Nutr Elder 2010; 29:87–99.
11. Sampathkumar K, Ramalingam R, Prabakar A, Abraham A. Acute interstitial nephritis due to proton pump inhibitors. Indian J Nephrol 2013; 23(4):304-307.
12. Lau AN, Tomizza M, Wong-Pack M, Papaioannou A, Adachi JD. The relationship between long-term proton pump inhibitor therapy and skeletal frailty. Endocrine 2015; 49:606-10.
13. Yang X-Y. Chronic proton pump inihibitor therapy and calcium metabolism. Curr Gastroenterol Rep 2012; 14:473-79.
14. Hansen KE, Jones AN, Lindstrom MJ, Davis LA, Ziegler TE, Penniston KL, et al. Do proton pump inhibitors decrease calcium absorption? J Bone Miner Res 2010; 25:2786-95.
15. Costa-Rodrigues J, Reis S, Teixeira S, Lopes S, Fernandes MH. Dose-dependent inhibitory effects of proton pump inhibitors on human osteoclastic and osteoblastic cell activity. FEBS J 2013; 280:5052-64.
16. Jo Y, Park E, Ahn SB, Jo YK, Son B, Kim SH, et al. A Proton Pump Inhibitor's Effect on Bone Metabolism Mediated by Osteoclast Action in Old Age: A Prospective Randomized Study. Gut Liver 2014; 9:607-14.
17. Ozdil K, Kahraman R, Sahin A, Calhan T, Gozden EH, Akyuz U, et al. Bone density in proton pump inhibitors users: a prospective study. Rheumatol Int 2013; 33:2255-60.
18. Rexhepi S, Bahtiri E, Rexhepi M, Sahatciu-Meka V, Rexhepi B. Association of Body Weight and Body Mass Index with Bone Mineral Density in Women and Men from Kosovo. Mater Sociomed 2015; 27:259-62.
19. Ito T, Jensen RT. Association of long-term proton pump inhibitor therapy with bone fractures and effects on absorption of calcium, vitamin B12, iron, and magnesium. Curr Gastroenterol Rep 2010; 12:448-57.
20. Al-Zahrany AA, AL Mourgi M. Risk of Osteoporosis and Osteopenia in Patients with Prolonged Use of Proton Pump Inhibitors. The Egyptian Journal of Hospital Medicine 2016; 65: 643- 647.
21. Panday K, Gona A, Humphrey MB. Medication-induced osteoporosis: screening and treatment strategies. Ther Adv Musculoskelet Dis 2014; 6:185-202.
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