The Association Between Prolonged Proton Pump Inhibitors Use and Bone Mineral Density.

Chronic use of proton-pump inhibitors (PPIs) has become a mainstay of therapy in common gastrointestinal diseases. A causal relationship between chronic PPI use and development of osteoporosis remains unproven. The aim of this study was to determine whether PPI users are more likely to develop alterations in bone density. In an analytical cross sectional study, patients who used PPIs for more than 2 years because of long-term gastroesophageal reflux disease (GERD) were recruited. PPI users were healthy people except for GERD. The compression group was randomly derived from an age-, sex- and physical activity-matched group from a healthy population in the National Registry of Osteoporosis who had not used PPIs in the previous 2 years. Bone mineral density was measured with dual-energy X-ray absorptiometry. Data regarding BMD and bone mineral content (BMC) of three regions: femoral neck, total hip, and the lumbar spine (L1-L4) were gathered and recorded. The World Health Organization (WHO) classification was used for definition of osteopenia and osteoporosis. A total of 394 participants (133 PPI users and 261 comparison group) were enrolled. The median duration of PPI use was 6.7 (2-31) years. The mean age ± SD of PPI users and comparison group was 48.38 ± 11.98 and 47.86 ± years, respectively (P = 0.681). There was no significant difference in baseline characteristics and age distribution between the two groups. The BMC levels were significantly lower in PPI users in all three regions: lumbar spine, total hip, and femoral neck (P<0.001). There were no significant differences in the T-scores between the two groups except for femoral neck (P<0.001). Osteoporosis in femoral neck was significantly higher in PPI users than in comparison group. This study showed that long-term use of PPIs is associated with lower BMC and higher rate of osteoporosis in the femoral neck. However, more studies with longitudinal evaluation should be performed to clarify this causal relationship. Until then, it is advised not to overuse PPIs because of the possible increase in risk of osteoporosis and the risk of fractures. We also recommend using the BMC levels as a quantitative measure in addition to T scores in analysis and reporting similar studies.

Fattahi MR ，Niknam R ，Shams M ，Anushiravani A ，Taghavi SA ，Omrani GR ，Mahmoudi L ... -  《Risk Management and Healthcare Policy》

Proton pump inhibitors use and change in bone mineral density.

Limited data are available reporting the effect of proton pump inhibitor (PPI) use on changes in bone mineral density (BMD). The aim of this study was to investigate the relationship between PPI use and BMD. The current cross-sectional study included 80 patients (31 male and 49 female) aged 20-45 years old without history of hip fracture with a follow-up of at least 2 years. The study was carried out in 40 daily PPI users and 40 PPI non-users. Femur and posterior-anterior spine BMD were quantified by dual-energy X-ray absorptiometry in all participants. The relationship between use of PPI and BMD was tested by multivariate linear regression analysis adjusted for age, sex, BMI and serum vitamin D levels. Our study demonstrated that mean femoral T-scores were significant between PPI and non-user groups (-0.44 ± 1.11 vs. +0.19 ± 0.95, P = 0.007). In addition, the frequency of femoral osteoporosis and osteopenia in the exposed group was significantly more in the control group (P = 0.04). Mean femoral Z-scores, lumbar spine T-score and lumbar spine Z-score were not statistically different between PPI and non-user groups. The linear regression analysis revealed that there was no association between PPI and non-users, and lumbar spine T-score. Overall, the results of this study showed that PPI use in subjects without risk factors of osteoporosis determined by the femoral T-score compared with the control group was associated with increased risk of developing osteoporosis and osteopenia in the femur bones.

Arj A ，Razavi Zade M ，Yavari M ，Akbari H ，Zamani B ，Asemi Z ... -  《-》

The relationship between proton pump inhibitor use and longitudinal change in bone mineral density: a population-based study [corrected] from the Canadian Multicentre Osteoporosis Study (CaMos).

Targownik LE ，Leslie WD ，Davison KS ，Goltzman D ，Jamal SA ，Kreiger N ，Josse RG ，Kaiser SM ，Kovacs CS ，Prior JC ，Zhou W ，CaMos Research Group ... -  《-》

Esomeprazole use is independently associated with significant reduction of BMD: 1-year prospective comparative safety study of four proton pump inhibitors.

Bahtiri E ，Islami H ，Hoxha R ，Qorraj-Bytyqi H ，Rexhepi S ，Hoti K ，Thaçi K ，Thaçi S ，Karakulak Ç ... -  《-》

Utilization of DXA Bone Mineral Densitometry in Ontario: An Evidence-Based Analysis.

Medical Advisory Secretariat 《-》