Inhibiting gastric acid production does not affect intestinal calcium absorption in young, healthy individuals: A randomized, crossover, controlled clinical trial

Abstract

Proton pump inhibitors (PPIs) are the most potent gastric acid suppressing drugs available, and their use is widespread. An emerging concern about chronic PPI therapy is whether these drugs impair intestinal calcium absorption, resulting in a negative calcium balance and thereby potentially causing bone loss. The objective of this study was to evaluate the acute effect of the PPI esomeprazole or placebo on intestinal calcium absorption in healthy adults. Twelve young adults participated in a placebo-controlled, double-blind, crossover study. There were two 3-week interventions that included a 14-day adjustment period (designed to stabilize calcium homeostasis) followed by 6 days of a diet containing 800 mg of calcium and 2.1 g/kg of protein (intervention). During the last 3 days of the adjustment period and throughout the intervention period, subjects consumed esomeprazole or placebo. Half the subjects underwent 24-hour continuous gastric acid pH monitoring. Intestinal calcium absorption was measured using dual-stable calcium isotopes at the end of each intervention. Treatment with esomprazole significantly increased gastric pH (mean pH on PPI 5.38 AE 0.13, mean pH on placebo 2.70 AE 0.44, p ¼ .005). Neither calcium absorption (PPI 34.2% AE 2.4%, placebo 31.5% AE 2.1%, p ¼ .24) nor urinary calcium (PPI 321 AE 38 mg/34 hours, placebo 355 AE 37 mg/34 hours, p ¼ .07) differed between the PPI and placebo groups. It is concluded that short-term gastric acid suppression by PPIs does not attenuate intestinal calcium absorption in healthy young adults. ß

The Relationship Between Proton Pump Inhibitor Use and Longitudinal Change in Bone Mineral Density: A Population-Based From the Canadian Multicentre Osteoporosis Study (CaMos)

“…However, the only studies that have demonstrated decreased calcium absorption among PPI users have been those that specifically assessed absorption of supplemental calcium carbonate in fasting individuals (26,27). In all other scenarios using different formulations of supplemental calcium or calcium ingestion associated with meals, no effects of PPIs on calcium absorption have been shown (33)(34)(35). It remains possible, nevertheless, that very marginal decrements in net calcium absorption may, over long periods of time, induce a large enough net calcium loss to cause clinically meaningful reductions in BMD (36).…”

Proton pump inhibitor use for 12 months is not associated with changes in serum magnesium levels: a prospective open label comparative study

“…In addition, our inability to assess vitamin D status and nutritional intake of magnesium and calcium limits the conclusion that detrimental effect on serum calcium levels is definitely attributed to PPIs. Ca carbonate consumed under fasting condition a decade ago, two other studies assessed calcium absorption using dual-stable calcium isotopes and found no changes in fractional calcium absorption, thus concluding no effect of PPI on calcium absorption and metabolism (26,27). Similarly, a recent study of Sharara et al (28) concluded no measurable effect of PPI intake on calcium metabolism.…”

The effect of dose and type of proton pump inhibitor use on risk of fractures and osteoporosis treatment in older Australian women: A prospective cohort study

“…One study found that PPI-users were more likely to subsequently be prescribed osteoporosis medication than non-users and that increased duration of therapy was associated with higher risks of osteoporosis medication prescription [1]. Three studies examining the effect of PPI use on calcium uptake used the dual isotope test (golden standard for intestinal calcium absorption) and these showed no evidence for decreased calcium absorption among PPI users [17][18][19].…”