Stomach and Duodenum (J Pisegna, Section Editor)

Current Gastroenterology Reports

, Volume 14, Issue 6, pp 473-479

First online:

Chronic Proton Pump Inihibitor Therapy and Calcium Metabolism

  • Yu-Xiao YangAffiliated withDivision of Gastroenterology, The Perelman School of Medicine at the University of PennsylvaniaCenter for Clinical Epidemiology and Biostatistics, and Department of Biostatistics and Epidemiology, The Perelman School of Medicine at the University of Pennsylvania Email author 

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Proton pump inhibitors (PPIs) have been widely used since their introduction in the late 1980s because they are highly effective for acid-related conditions. However, some recent epidemiological studies have suggested a positive association between PPI therapy and the risk of osteoporotic fractures. The potential mechanisms underlying this association may be related to the physiologic effects of chronic acid suppression on calcium metabolism. First, chronic hypergastrinemia induced by PPI therapy may lead to parathyroid hyperplasia, resulting in increased loss of calcium from the bone. Second, profound gastric acid suppression may reduce the bioavailability of calcium for intestinal absorption. I will review the published evidence regarding these potential links and discuss their clinical implications.


Proton pump inhibitors Hypergastrinemia Hyperparathyroidism Calcium absorption Osteoporosis PPIs and calcium metabolism PPI-induced hypergastrinemia Parathyroid glands Bone metabolism Calcium balance