Proton pump inhibitors, bone and phosphocalcic metabolism

Area of Science:

• Gastroenterology
• Nephrology
• Endocrinology
• Rheumatology

Background:

• Proton pump inhibitors (PPIs) are common treatments for acid-related gastrointestinal issues.
• Concerns exist regarding prolonged and inappropriate PPI use.
• Emerging evidence links PPIs to adverse effects, including kidney disease, pneumonia, dementia, cardiovascular events, and bone health problems.

Purpose of the Study:

• To systematically review the effects of PPIs on bone health.
• To analyze PPIs' impact on osteoporosis, bone mineral density (BMD), fracture risk, and phosphocalcic and magnesium metabolism.

Main Methods:

• Comprehensive literature analysis of recent studies.
• Examination of observational studies and meta-analyses on PPI use and bone health outcomes.
• Focus on populations with comorbidities.

Main Results:

• Studies on PPIs and BMD show mixed results, necessitating further investigation.
• Observational data suggest an increased risk of fractures, particularly vertebral and hip fractures, with PPI use, potentially dose-dependent.
• PPIs are linked to significant disturbances in magnesium and calcium metabolism, including PPI-induced hypomagnesemia (PPIH) and secondary hypocalcemia.

Conclusions:

• PPI use is associated with potential risks to bone health, including increased fracture risk and metabolic disturbances.
• While observational studies indicate associations, causal relationships require further research.
• Judicious PPI prescription practices are crucial, particularly for long-term use and in rheumatological contexts, to mitigate potential harms.