Risk of Osteoporosis and Osteopenia in Patients with Prolonged Use of Proton Pump Inhibitors

Background and aim of the work: several studies suggest that proton pump inhibitors (PPIs) use may be involved in development and acceleration of osteoporosis. The aim of this study is to investigate the relationships between prolonged uses of PPIs in patients with gastro-esophageal reflux disease (GERD) and to reveal their possible role in development of osteopenia or osteoporosis with evaluation of different diagnostic tools which help in follow up of those patients. Patient and methods: This prospective controlled study which was conducted at King Abdul Aziz Specialist Hospital in Taif, Saudi Arabia, from January 2013 to June 2016.  We compared the prevalence of osteoporosis or osteopenia in 2 groups of individuals, the first group; of 30 patients using PPIs as treatment of GERD for more than 2 years. The second group included thirty healthy control subjects .In both groups we measured the bone mineral density using the dual energy X-ray absorptiometry (DEXA), calcium (Ca), inorganic phosphorus (P), serum alkaline phosphatase, and deoxypyridinoline (DPD) in urine. Results: there were no significant differences between the 2 groups as regards, age, gender, and their clinical history (P > 0.05), however, the history of fragility fracture was significantly higher in PPIs group of patients (P 0.05). The serum alkaline phosphatase and urinary DPD were higher than normal reference levels, but, significantly higher in patients receiving PPIs (P< 0.05). The number of osteopenic/osteoporotic patients was significantly higher in PPIs group than in control group (P< 0.05). Osteopenia and osteoporosis were significantly correlated in PPIs group with male gender, younger age group of patients (P< 0.05), and the correlation was highly significant with the duration of use of the drug (P<0.001). In control group the decrease in bone density was significantly correlated with the female gender and to older group of patients (P< 0.05). Conclusion: in GERD patient using PPIs, the osteopenic/osteoporotic effect with increased possibility of fragility fractures must be discussed with the patient if prolonged use of these drugs is expected,  taking in consideration the potential safety and reliability of laparoscopic or thoracoscopic surgical options as alternative therapy.