Long-Term Proton Pump Inhibitor Use Is Not Associated With Changes in Bone Strength and Structure

Area of Science:

• Bone Metabolism and Biomechanics
• Pharmacology and Therapeutics

Background:

• Observational studies suggest a link between proton pump inhibitor (PPI) use and increased fracture risk.
• The causal relationship remains unclear due to a lack of defined mechanisms and evidence of PPIs affecting bone mineral density (BMD).
• Potential for PPIs to alter bone structure, independent of BMD, predisposing to fractures.

Purpose of the Study:

• To investigate if long-term PPI use is associated with structural bone changes using three-dimensional quantitative computed tomography (3D-QCT).
• To determine if these structural changes occur independently of areal bone mineral density (aBMD).

Main Methods:

• A cohort of long-term PPI users (≥5 years) was matched with a control group of non-users.
• aBMD was assessed using dual-energy X-ray absorptiometry (DXA).
• Volumetric BMD, bone metabolism markers, and bone strength indices (buckling ratio, section modulus) were evaluated using 3D-QCT.

Main Results:

• No significant differences in aBMD, volumetric BMD, or bone metabolism markers were found between PPI users and non-users.
• Measures of bone strength, including buckling ratio and section modulus, were comparable between the two groups.
• 104 subjects (52 PPI users, 52 non-users) were enrolled.

Conclusions:

• Long-term PPI use is not associated with alterations in bone mineral density or bone strength.
• These findings suggest that the observed association between PPI use and fracture risk is likely not causal.
• Further research may be needed to fully elucidate the relationship between PPIs and skeletal health.