title: A Proton Pump Inhibitor's Effect on Bone Metabolism Mediated by Osteoclast Action in Old Age: A Prospective Randomized Study.
abstract: OBJECTIVE
  Proton pump inhibitors (PPIs) act by irreversibly binding to the H(+)-K(+)-ATPase of the proton pump in parietal cells and may possibly affect the vacuolar H(+)-ATPase in osteoclasts.
  
  
  METHODS
  We investigated the effect of 8 weeks of PPI treatment on the parameters of bone turnover and compared PPI with revaprazan, which acts by reversibly binding to H(+)-K(+)-ATPase in proton pumps. This study was a parallel randomized controlled trial. For 8 weeks, either a PPI or revaprazan was randomly assigned to patients with gastric ulcers. The parameters of bone turnover were measured at the beginning of and after the 8-week treatment period.
  
  
  RESULTS
  Twenty-six patients (PPI, n=13; revaprazan, n=13) completed the intention-to-treat analysis. After the 8-week treatment period, serum calcium and urine deoxypyridinoline (DPD) were increased in the PPI group (serum calcium, p=0.046; urine DPD, p=0.046) but not in the revaprazan group. According to multivariate linear regression analysis, age ≥60 years was an independent predictor for the changes in serum calcium and urine DPD.
  
  
  CONCLUSIONS
  In elderly patients, administering a PPI for 8 weeks altered bone parameters. Our study suggested that PPIs might directly alter bone metabolism via the vacuolar H(+)-ATPase in osteoclasts.
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Eulji General Hospital, Eulji University School of Medicine, Seoul, Korea.
authors.forename: Yunju
authors.initials: Y
authors.lastname: Jo
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Eulji General Hospital, Eulji University School of Medicine, Seoul, Korea.
authors.forename: Eunkyoung
authors.initials: E
authors.lastname: Park
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Eulji General Hospital, Eulji University School of Medicine, Seoul, Korea.
authors.forename: Sang Bong
authors.initials: SB
authors.lastname: Ahn
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Eulji General Hospital, Eulji University School of Medicine, Seoul, Korea.
authors.forename: Young Kwan
authors.initials: YK
authors.lastname: Jo
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Eulji General Hospital, Eulji University School of Medicine, Seoul, Korea.
authors.forename: Byungkwan
authors.initials: B
authors.lastname: Son
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Eulji General Hospital, Eulji University School of Medicine, Seoul, Korea.
authors.forename: Seong Hwan
authors.initials: SH
authors.lastname: Kim
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Eulji General Hospital, Eulji University School of Medicine, Seoul, Korea.
authors.forename: Young Sook
authors.initials: YS
authors.lastname: Park
authors.affiliation: Division of Endocrinology, Department of Internal Medicine, Eulji General Hospital, Eulji University School of Medicine, Seoul, Korea.
authors.forename: Hyo Jeong
authors.initials: HJ
authors.lastname: Kim
mesh_terms: D000368:Aged; D000596:Amino Acids / Q000187:drug effects / Q000652:urine; D016723:Bone Remodeling / Q000187:drug effects*; D001842:Bone and Bones / Q000378:metabolism*; D002118:Calcium / Q000097:blood; D005260:Female; D006801:Humans; D057194:Intention to Treat Analysis; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010010:Osteoclasts / Q000378:metabolism*; D011446:Prospective Studies; D054328:Proton Pump Inhibitors / Q000494:pharmacology*; D011744:Pyrimidinones / Q000494:pharmacology*; D044005:Tetrahydroisoquinolines / Q000494:pharmacology*
chemical_list: D000596:Amino Acids; D054328:Proton Pump Inhibitors; D011744:Pyrimidinones; D044005:Tetrahydroisoquinolines; C108798:YH 1885; C036020:deoxypyridinoline; D002118:Calcium
keywords: Bone metabolism; Hydrogen potassium ATPase; Osteoclasts; Osteoporosis; Proton pump inhibitors