Proton pump inhibitor therapy and osteoporosis.
Osteoporotic fractures, particularly hip fractures, can have a devastating impact on the well-being of the elderly population. Recently, two population-based observational studies reported a highly important association between the use of potent acid suppressive therapy and an increased risk of hip fractures. The mechanisms underlying such an association are not clear. However, a careful review of the existing evidence seems to suggest that the main physiologic consequences of proton pump inhibitor therapy may each have a theoretical influence on bone metabolism. Specifically, inhibition of the osteoclastic proton pumps may reduce bone resorption, while profound acid suppression could potentially hamper intestinal calcium absorption, and secondary hypergastrinemia may enhance bone resorption through the induction of parathyroid gland hyperplasia. However, the existing data are clearly too limited for us to draw any definitive conclusions, and more studies are urgently needed to delineate the physiologic relevance of these theoretical mechanistic links, individually and collectively.
Yang
Yu-Xiao
YX
Division of Gastroenterology, Center for Clinical Epidemiology and Biostatistics, and Department of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA. yangy@mail.med.upenn.edu
D000818:Animals; D016723:Bone Remodeling / Q000187:drug effects; D002118:Calcium / Q000378:metabolism; D002986:Clinical Trials as Topic; D050723:Fractures, Bone / Q000139:chemically induced*; D006801:Humans; D010024:Osteoporosis / Q000139:chemically induced* / Q000378:metabolism; D054328:Proton Pump Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D012307:Risk Factors
D054328:Proton Pump Inhibitors; D002118:Calcium