Effect of long-term proton pump inhibitors on bone mineral density

Abstract

Background: Proton pump inhibitors (PPIs) are widespread nowadays. Recent concerns have emerged about possible bone complications of their long-term use, as low bone mineral density (BMD) and an increased risk of fractures. Aim: To evaluate the effect of long-term use of PPIs on bone by estimating the frequency of osteopenia and osteoporosis, and determining the risk factors associated to these complications. Methods: A prospective study including consecutive patients taking PPI for at least one year. All patients underwent bone densitometry, and FRAX score was calculated to estimate the risk of osteoporotic fracture. Results: We included 52 patients with a mean age of 49.5 years and a male-female ratio of 0,48. Mean duration of PPI intake was 45 months. The most frequent indication was gastroesophageal reflux disease. PPI prescription was appropriate in 94% of cases. The calculated daily calcium intake was in majority insufficient (94%). Approximately half of patients had at least three risk factors. Osteopenia and osteoporosis were observed in 52% and 19% respectively. Predictive factors of low BMD were an age ≥50 years, menopause, calcium intake ≤550mg/day and a PPI use duration≥30 months. FRAX score was significantly higher when BMD was lower. The multivariate analysis could not be undertaken because of co linearity of the factors. Conclusion: Long-term PPI use is associated with risk of bone complications, especially among patients at risk for osteoporosis. It seems reasonable to be more vigilant in prescribing PPIs and to use the lowest effective dose for patients with appropriate indications.