Effect of Chronic Proton Pump Inhibitor Therapy on Bone Mineral Density and Bone Structure in Mid to Late Adulthood
Proton pump inhibitors (PPIs) are among the most widely used medications. It is becoming
increasingly common for patients to take these potent acid suppressants on a long-term and
continuous basis for erosive esophagitis, Barrett's esophagus and protection against
nonsteroidal anti-inflammatory drug-related gastropathy. PPI therapy leads to elevated serum
gastrin levels and may impair the absorption of calcium and food-bound vitamin B12.
PPI-induced hypergastrinemia has a direct trophic effect on the parathyroid glands, leading
to parathyroid hyperplasia, increased parathyroid hormone secretion and bone loss.
Furthermore, both calcium malabsorption and vitamin B12 deficiency are associated with
reduced bone mineral density (BMD) and increased osteoporotic fracture risk. Consistent with
these data, recent studies revealed a positive association between PPI therapy and the risk
of osteoporotic fractures. Peripheral quantitative computed tomography (pQCT) can provide a
three-dimensional structural analysis of trabecular and cortical volumetric BMD (vBMD) and
dimensions. These data are imperative for a valid assessment of the effect of chronic PPI
therapy on bone strength. The investigators hypothesize that PPI therapy leads to decreased
cortical and trabecular vBMD, cortical dimensions and bone strength.
Observational Model: Cohort, Time Perspective: Prospective
Volumetric bone mineral density as measured by pQCT
Yu-Xiao Yang, MD, MSCE
University of Pennsylvania
United States: Institutional Review Board
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