Association of Long-Term Proton Pump Inhibitor Therapy with Bone Fractures and Effects on Absorption of Calcium, Vitamin B12, Iron, and Magnesium

Abstract

Proton pump inhibitors (PPI) are now one of the most widely used classes of drugs. PPIs have proven to have a very favorable safety profile and it is unusual for a patient to stop these drugs because of side effects. However, increasing numbers of patients are chronically taking PPIs for gastroesophageal reflux disease and a number of other common persistent conditions, therefore the long-term potential adverse effects are receiving increasing attention. One area that is receiving much attention and generally has been poorly studied, is the long-term effects of chronic acid suppression on the absorption of vitamins and nutrients. This area has received increased attention because of the reported potential adverse effect of chronic PPI treatment leading to an increased occurrence of bone fractures. This has led to an increased examination of the effects of PPIs on calcium absorption/metabolism as well as numerous cohort, case control and prospective studies of their ability to affect bone density and cause bone fractures. In this article these studies are systematically examined, as well as the studies of the effects of chronic PPI usage on VB12, iron and magnesium absorption. In general the studies in each of thee areas have led to differing conclusions, but when examined systematically, a number of the studies are showing consistent results that support the conclusion that long-term adverse effects on these processes can have important clinical implications.

Impact of Roux-en-Y Gastric Bypass Surgery (Rygb) on Metabolic Syndrome Components and on the Use of Associated Drugs in Obese Patients

“…It is noteworthy that the absorption of some vitamins and minerals is decreased by several factors: restriction of food intake, change in nutrient absorption, and the use of gastroprotective drugs that change the pH of the stomach and decrease the absorption of iron and calcium. Additionally, gastroprotective drugs are associated with the depletion of some micronutrients, such as iron (13) . Iron and folic acid are micronutrients that are essential for normal metabolism, and deficiencies of these micronutrients may cause health hazards, including the development of chronic diseases such as CVD (10) .…”

“…Obesity has been considered a worldwide epidemic, and projections indicate that by 2030, 55 million individuals will die because of obesity (11,13,19) . Developing countries, such as Brazil, are experiencing an alarming growth of obesity and chronic non-communicable diseases.…”

Determinants of Gastroesophageal Reflux Disease (GERD) severity and Utilization of Proton Pump Inhibitors among GERD Patients: A Cross-Sectional Study

“…Protracted usage of PPIs can lead to its long term adverse effects such as chronic kidney disease (CKD), Clostridium difficile infection (CDI), community-acquired pneumonia (CAP), osteoporosis etc (Gikas et al, 2014, Ito et al, 2010, Heidelbaugh et al, 2012. Since, long-term treatment is required for most of the gastric-acid related disorders, in patients who are receiving other medications in conjunction with a PPI, the risk for clinically significant adverse drug interactions are probable.…”

Uso de inhibidores de la bomba de protones y antagonistas de los receptores H2 de histamina como profilaxis en úlceras por estrés: ¿una práctica justificada?

“…Desde su introducción al mercado en los años de 1990, han aumentado el uso y la prescripción de los inhibidores de la bomba de protones debido a su alta eficacia en el tratamiento de la enfermedad por reflujo gastroesofágico, y han remplazando a los antagonistas H2 en este papel; en el 2009 este tipo de inhibidores se convirtieron en el tercer medicamento más vendido en Estados Unidos con más de 119 millones de prescripciones anuales (1)(2)(3)(4)(5). Intrahospitalariamente se ha evidenciado un sobreuso entre 30 y 60% de los pacientes (6-9); en Colombia en un estudio con pacientes no hospitalizados se encontró que el 2,7% de las prescripciones correspondían a inhibidores de la bomba de protones, entre los cuales el omeprazol fue el más prescrito (97,8%) e intrahospitalariamente se identificó un uso injustificado de protectores de la mucosa gástrica de hasta 62% con omeprazol y 65,9% con ranitidina (10)(11)(12).…”