Proton Pump Inhibitors and Bone Health: An Update Narrative Review

Abstract

Proton pump inhibitors (PPIs) are an antacid drug often used in acid-related disorders. They decrease acid secretion in the stomach by blocking an enzyme called H+/K+ ATPase which controls acid production. Introduced to the market in 1989, their use has increased rapidly worldwide and they are now among the top 10 most prescribed drugs in the United States. As of 2015, the FDA has already approved six drugs of this class (omeprazole, esomeprazole, lansoprazole, dexlansoprazole, pantoprazole and rabeprazole). Recently, the risks and benefits of long-term PPI use were questioned and many studies indicated that their use should be carefully considered, especially in young patients, whose treatment with these drugs could last many years. Even greater concerns have been raised about a potential positive association between PPIs and osteoporotic fracture risk including the hip, spine and wrist. Although based on observational studies, there is substantial evidence associating the long-term use of PPIs and fracture. This relationship is only partially admitted due to the lack of consistent effects of PPIs on bone mineral density loss. Therefore, this narrative review aimed to discuss the recent findings pertaining to the risk of osteoporotic fracture associated with PPIs, in particular prolonged use, and to call for further research to elucidate the mechanisms associated with this bone fragility.

Individualized prevention of proton pump inhibitor related adverse events by risk stratification

“…PPI interference with the microbiome, hypergastrinemia, and potential impacts on central nervous system immune activity are suggested mechanisms for depressive disorders 47 . Beyond microbial effects, diminished gastric acidity in PPI users causes calcium or vitamin B12 malabsorption, decreasing bone mineral density and elevating the risk of osteoporosis and falls 48 . In addition, PPIs may affect cardiovascular risk by modulating plasma asymmetric dimethylarginine, reducing nitric oxide levels, and impairing endothelium-dependent vasodilation 49 .…”

The Characteristic of the Gastric Secretion After Gastric Cryodenervation and Cryopreserved Placenta Extract Administration

“…ІПП блокують функцію протонної помпи в парієтальних клітинах, що відповідають за вироблення кислоти, тим самим знижуючи рівень кислотності шлункового соку. ІПП широко використовуються в лікуванні із пептичними виразками [43,44].…”

Association between proton pump inhibitors and risk of hepatic encephalopathy in patients undergoing transjugular intrahepatic portosystemic shunt: a protocol for a systematic review and meta-analysis

“…Although PPIs are typically regarded to have a high safety profile, various unfavourable adverse effects, including diarrhoea and bone disease, have been reported. Furthermore, PPI use may be an accurate indicator of mortality in patients with cirrhosis 10 11. Although the pathophysiology of HE is not completely understood, an association between HE and gut flora has long been suspected and a negative association between altered intestinal dysbiosis and the occurrence and severity of HE after TIPS has been reported.…”