Skip to main content

Advertisement

SpringerLink
Log in

Bone density in proton pump inhibitors users: a prospective study

  • Original Article
  • Published:
Rheumatology International Aims and scope Submit manuscript

An Erratum to this article was published on 23 August 2016

Abstract

Patients with gastroesophageal reflux disease (GERD) receive long-term therapy with proton pump inhibitor (PPI) agents. Several studies have recently been published suggesting that treatment with PPI may cause bone fractures, although the number of prospective studies in this regard is limited. The aim of this study is to prospectively investigate the effect of PPIs on bone density. Between March 2009 and January 2011, 114 GERD patients (18–56 years) and 110 healthy controls were included in the present study. Bone mineral densitometry (BMD) by using dual-energy X-ray absorptiometry was assessed at lumbar spine and femur neck. BMD measurements were performed on all subjects at the beginning of the study. The patients were divided according to three drugs by their treatment with esomeprazole, lansoprazole, or pantoprazole. The study group was followed for at least 6 months on PPI therapy, and then BMD measurements were repeated. The mean duration of treatment with PPIs was 8.5 ± 2.3 months. In patients receiving PPIs, the mean reduction in total vertebra T score following treatment compared to pre-treatment values was 00.23 ± 0.42 units (95 % CI 0.15–0.30) (p < 0.01), while the mean reduction in the femur T score was 0.10 ± 0.40 units (95 % CI 0.03–0.18) (p = 0.03). Reduction following treatment in L4 and total vertebra T scores of lansoprazole group was significantly higher than of pantoprazole group (p = 0.04). Reduction in femur T score of esomeprazole group was higher than of lansoprazole group and pantroprazole group, but it is not statistically significant. Treatment with a PPI results in a significant reduction in bone density. Close monitoring is beneficial for patients who are to receive long-term treatment with PPI.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Mazziotti G, Canalis E, Giustina A (2010) Drug-induced osteoporosis: mechanisms and clinical implications. Am J Med 123(10):877–884. doi:10.1016/j.amjmed.2010.02.028

    Article  PubMed  CAS  Google Scholar 

  2. Graziani G, Badalamenti S, Como G, Gallieni M, Finazzi S, Angelini C, Brancaccio D, Ponticelli C (2002) Calcium and phosphate plasma levels in dialysis patients after dietary Ca–P overload. Role of gastric acid secretion. Nephron 91(3):474–479

    Article  PubMed  CAS  Google Scholar 

  3. O'Connell MB, Madden DM, Murray AM, Heaney RP, Kerzner LJ (2005) Effects of proton pump inhibitors on calcium carbonate absorption in women: a randomized crossover trial. Am J Med 118(7):778–781. doi:10.1016/j.amjmed.2005.02.007

    Article  PubMed  Google Scholar 

  4. Yang YX (2008) Proton pump inhibitor therapy and osteoporosis. Curr Drug Saf 3(3):204–209

    Article  PubMed  CAS  Google Scholar 

  5. Gagnemo-Persson R, Samuelsson A, Hakanson R, Persson P (1997) Chicken parathyroid hormone gene expression in response to gastrin, omeprazole, ergocalciferol, and restricted food intake. Calcif Tissue Int 61(3):210–215

    Article  PubMed  CAS  Google Scholar 

  6. Tuukkanen J, Vaananen HK (1986) Omeprazole, a specific inhibitor of H+–K+–ATPase, inhibits bone resorption in vitro. Calcif Tissue Int 38(2):123–125

    Article  PubMed  CAS  Google Scholar 

  7. Yang YX, Lewis JD, Epstein S, Metz DC (2006) Long-term proton pump inhibitor therapy and risk of hip fracture. JAMA 296(24):2947–2953. doi:10.1001/jama.296.24.2947

    Article  PubMed  CAS  Google Scholar 

  8. de Vries F, Cooper AL, Cockle SM, van Staa TP, Cooper C (2009) Fracture risk in patients receiving acid-suppressant medication alone and in combination with bisphosphonates. Osteoporos Int 20(12):1989–1998. doi:10.1007/s00198-009-0891-4

    Article  PubMed  CAS  Google Scholar 

  9. Vestergaard P, Rejnmark L, Mosekilde L (2006) Proton pump inhibitors, histamine H2 receptor antagonists, and other antacid medications and the risk of fracture. Calcif Tissue Int 79(2):76–83. doi:10.1007/s00223-006-0021-7

    Article  PubMed  CAS  Google Scholar 

  10. Targownik LE, Lix LM, Metge CJ, Prior HJ, Leung S, Leslie WD (2008) Use of proton pump inhibitors and risk of osteoporosis-related fractures. CMAJ 179(4):319–326. doi:10.1503/cmaj.071330

    PubMed  Google Scholar 

  11. McGowan B, Bennett K, Barry M (2010) Prescribing of anti-osteoporotic therapies following the use of proton pump inhibitors in general practice. Pharmacoepidemiol Drug Saf 19(7):763–769. doi:10.1002/pds.1972

    Article  PubMed  CAS  Google Scholar 

  12. Leslie WD, Tsang JF, Caetano PA, Lix LM (2007) Effectiveness of bone density measurement for predicting osteoporotic fractures in clinical practice. J Clin Endocrinol Metab 92(1):77–81. doi:10.1210/jc.2006-1415

    Article  PubMed  CAS  Google Scholar 

  13. Sheikh MS, Santa Ana CA, Nicar MJ, Schiller LR, Fordtran JS (1987) Gastrointestinal absorption of calcium from milk and calcium salts. N Engl J Med 317(9):532–536. doi:10.1056/NEJM198708273170903

    Article  PubMed  CAS  Google Scholar 

  14. Gray SL, LaCroix AZ, Larson J, Robbins J, Cauley JA, Manson JE, Chen Z (2010) Proton pump inhibitor use, hip fracture, and change in bone mineral density in postmenopausal women: results from the Women's Health Initiative. Arch Intern Med 170(9):765–771. doi:10.1001/archinternmed.2010.94

    Article  PubMed  Google Scholar 

  15. Corley DA, Kubo A, Zhao W, Quesenberry C (2010) Proton pump inhibitors and histamine-2 receptor antagonists are associated with hip fractures among at-risk patients. Gastroenterology 139(1):93–101. doi:10.1053/j.gastro.2010.03.055

    Article  PubMed  Google Scholar 

  16. Karsdal MA, Henriksen K, Sorensen MG, Gram J, Schaller S, Dziegiel MH, Heegaard AM, Christophersen P, Martin TJ, Christiansen C, Bollerslev J (2005) Acidification of the osteoclastic resorption compartment provides insight into the coupling of bone formation to bone resorption. Am J Pathol 166(2):467–476. doi:10.1016/S0002-9440(10)62269-9

    Article  PubMed  CAS  Google Scholar 

  17. Mattsson JP, Vaananen K, Wallmark B, Lorentzon P (1991) Omeprazole and bafilomycin, two proton pump inhibitors: differentiation of their effects on gastric, kidney and bone H(+)-translocating ATPases. Biochim Biophys Acta 1065(2):261–268

    Article  PubMed  CAS  Google Scholar 

  18. Mizunashi K, Furukawa Y, Katano K, Abe K (1993) Effect of omeprazole, an inhibitor of H+, K(+)-ATPase, on bone resorption in humans. Calcif Tissue Int 53(1):21–25

    Article  PubMed  CAS  Google Scholar 

  19. Yu EW, Blackwell T, Ensrud KE, Hillier TA, Lane NE, Orwoll E, Bauer DC (2008) Acid-suppressive medications and risk of bone loss and fracture in older adults. Calcif Tissue Int 83(4):251–259. doi:10.1007/s00223-008-9170-1

    Article  PubMed  CAS  Google Scholar 

  20. Targownik LE, Lix LM, Leung S, Leslie WD (2010) Proton-pump inhibitor use is not associated with osteoporosis or accelerated bone mineral density loss. Gastroenterology 138(3):896–904. doi:10.1053/j.gastro.2009.11.014

    Article  PubMed  CAS  Google Scholar 

  21. Rejnmark L (2008) Cardiovascular drugs and bone. Curr Drug Saf 3(3):178–184

    Article  PubMed  CAS  Google Scholar 

Download references

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Department of Gastroenterology, Umraniye Training and Research Hospital, Adem Yavuz Cad. No: 1, Umraniye-Istanbul, Turkey

    Kamil Ozdil, Resul Kahraman, Abdurrahman Sahin, Turan Calhan & Mehmet H. Sokmen

  2. Department of Internal Medicine, Umraniye Training and Research Hospital, Adem Yavuz Cad. No: 1, Umraniye-Istanbul, Turkey

    Erdem H. Gozden

  3. Department of Gastroenterology, Fatih Sultan Mehmet Training and Research Hospital, FSM Hastanesi, E5 karayolu üzeri, Bostancı, Istanbul, Turkey

    Umit Akyuz

  4. Department of Rheumatology, Istanbul Medical Faculty, Istanbul Tıp Fakültesi, Fatih, Istanbul, Turkey

    Burak Erer

Authors
  1. Kamil Ozdil
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Resul Kahraman
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Abdurrahman Sahin
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Turan Calhan
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Erdem H. Gozden
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Umit Akyuz
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Burak Erer
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Mehmet H. Sokmen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Abdurrahman Sahin.

Additional information

An erratum to this article is available at http://dx.doi.org/10.1007/s00296-016-3554-8.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ozdil, K., Kahraman, R., Sahin, A. et al. Bone density in proton pump inhibitors users: a prospective study. Rheumatol Int 33, 2255–2260 (2013). https://doi.org/10.1007/s00296-013-2709-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00296-013-2709-0

Keywords

Search

Navigation