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The Association Between Prolonged Proton Pump Inhibitors Use and Bone Mineral Density
BACKGROUND AND STUDY AIM: 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 mo...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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Dove
2019
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Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6914803/ https://www.ncbi.nlm.nih.gov/pubmed/31853206 http://dx.doi.org/10.2147/RMHP.S223118 |
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author | Fattahi, Mohammad Reza Niknam, Ramin Shams, Mesbah Anushiravani, Amir Taghavi, Seyed Alireza Omrani, Gholamhossein Ranjbar Mahmoudi, Laleh |
author_facet | Fattahi, Mohammad Reza Niknam, Ramin Shams, Mesbah Anushiravani, Amir Taghavi, Seyed Alireza Omrani, Gholamhossein Ranjbar Mahmoudi, Laleh |
author_sort | Fattahi, Mohammad Reza |
collection | PubMed |
description | BACKGROUND AND STUDY AIM: 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. PATIENTS AND METHODS: 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. RESULTS: 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. CONCLUSION: 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. |
format | Online Article Text |
id | pubmed-6914803 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | Dove |
record_format | MEDLINE/PubMed |
spelling | pubmed-69148032019-12-18 The Association Between Prolonged Proton Pump Inhibitors Use and Bone Mineral Density Fattahi, Mohammad Reza Niknam, Ramin Shams, Mesbah Anushiravani, Amir Taghavi, Seyed Alireza Omrani, Gholamhossein Ranjbar Mahmoudi, Laleh Risk Manag Healthc Policy Original Research BACKGROUND AND STUDY AIM: 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. PATIENTS AND METHODS: 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. RESULTS: 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. CONCLUSION: 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. Dove 2019-12-12 /pmc/articles/PMC6914803/ /pubmed/31853206 http://dx.doi.org/10.2147/RMHP.S223118 Text en © 2019 Fattahi et al. http://creativecommons.org/licenses/by-nc/3.0/ This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms (https://www.dovepress.com/terms.php). |
spellingShingle | Original Research Fattahi, Mohammad Reza Niknam, Ramin Shams, Mesbah Anushiravani, Amir Taghavi, Seyed Alireza Omrani, Gholamhossein Ranjbar Mahmoudi, Laleh The Association Between Prolonged Proton Pump Inhibitors Use and Bone Mineral Density |
title | The Association Between Prolonged Proton Pump Inhibitors Use and Bone Mineral Density |
title_full | The Association Between Prolonged Proton Pump Inhibitors Use and Bone Mineral Density |
title_fullStr | The Association Between Prolonged Proton Pump Inhibitors Use and Bone Mineral Density |
title_full_unstemmed | The Association Between Prolonged Proton Pump Inhibitors Use and Bone Mineral Density |
title_short | The Association Between Prolonged Proton Pump Inhibitors Use and Bone Mineral Density |
title_sort | association between prolonged proton pump inhibitors use and bone mineral density |
topic | Original Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6914803/ https://www.ncbi.nlm.nih.gov/pubmed/31853206 http://dx.doi.org/10.2147/RMHP.S223118 |
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