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Fitzpatrick D, Lannon R, Laird E, Ward M, Hoey L, Hughes CF, Strain JJ, Cunningham C, McNulty H, Molloy AM, McCarroll K. The association between proton pump inhibitors and hyperparathyroidism: a potential mechanism for increased fracture-results of a large observational cohort study. Osteoporos Int 2023; 34:1917-1926. [PMID: 37530847 PMCID: PMC10579148 DOI: 10.1007/s00198-023-06867-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 07/19/2023] [Indexed: 08/03/2023]
Abstract
Proton pump inhibitors (PPIs) are associated with increased risk of osteoporotic fracture; however, the mechanism is unclear. PPI users taking calcium supplements were more likely to have hyperparathyroidism compared to non-users (OR 1.56, CI 1.08-2.23, p = 0.018). This highlights the importance of monitoring PPI use, especially in older adults. PURPOSE Proton pump inhibitors (PPIs) are associated with increased risk of osteoporotic fracture. Hyperparathyroidism may be implicated, but few studies have considered this relationship. This study evaluated the relationship between PPI use and hyperparathyroidism in older adults. METHODS Participants were from the TUDA study, a large cross-sectional cohort of older Irish adults. Participants with an estimated glomerular filtration rate (eGFR) < 30 ml/min and serum calcium > 2.5 mmol/l were excluded to avoid hyperparathyroidism due to chronic renal disease and primary hyperparathyroidism. Hyperparathyroidism was defined as a parathyroid hormone (PTH) > 65 pg/ml. Multivariate regression models were used to analyse the relationship between PPI use and hyperparathyroidism. RESULTS A total of 4139 participants met the inclusion criteria, of whom 37.8% (n = 1563) were taking PPI medication. PPI use was identified in 41.4% of calcium supplement users and 35.4% of non-calcium supplement users. Overall, compared to non-users of PPIs, those taking PPIs were older (74.8 vs 72.9 years, p < 0.001) and had a higher prevalence of hyperparathyroidism (17.8 vs 11.0%, p < 0.001). In those taking calcium supplements (but not in non-users), PPI use was significantly associated with hyperparathyroidism (OR 1.56, CI 1.08-2.23, p = 0.018) after adjusting for age, sex, body mass index, serum vitamin D, eGFR, timed-up-and-go, dairy intake, medications, and comorbidities. DISCUSSION The results are consistent with the hypothesis of PPIs reducing calcium absorption, leading to a rise in PTH which could mediate increased fracture risk. No relationship of PPI use with hyperparathyroidism was observed in non-users of calcium supplements, possibly owing to lower dietary calcium intake. These results highlight the importance of monitoring PPI use, especially in older adults at risk of fracture.
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Affiliation(s)
- Donal Fitzpatrick
- The Mercers Institute for Research On Ageing, St James's Hospital, Dublin, Ireland.
| | - Rosaleen Lannon
- The Mercers Institute for Research On Ageing, St James's Hospital, Dublin, Ireland
- School of Medicine, Trinity College, Dublin, Ireland
| | - Eamon Laird
- Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland
| | - Mary Ward
- Nutrition Innovation Centre for Food and Health, University of Ulster, Coleraine, BT52 1SA, Northern Ireland
| | - Leane Hoey
- Nutrition Innovation Centre for Food and Health, University of Ulster, Coleraine, BT52 1SA, Northern Ireland
| | - Catherine F Hughes
- Nutrition Innovation Centre for Food and Health, University of Ulster, Coleraine, BT52 1SA, Northern Ireland
| | - J J Strain
- Nutrition Innovation Centre for Food and Health, University of Ulster, Coleraine, BT52 1SA, Northern Ireland
| | - Conal Cunningham
- The Mercers Institute for Research On Ageing, St James's Hospital, Dublin, Ireland
| | - Helene McNulty
- Nutrition Innovation Centre for Food and Health, University of Ulster, Coleraine, BT52 1SA, Northern Ireland
| | - Anne M Molloy
- School of Medicine, Trinity College, Dublin, Ireland
| | - Kevin McCarroll
- The Mercers Institute for Research On Ageing, St James's Hospital, Dublin, Ireland
- School of Medicine, Trinity College, Dublin, Ireland
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Kondapalli A, Agarwal S, Germosen C, Bucovsky M, Colon I, Kil N, Walker M. Bone microstructure in proton pump inhibitor users. Bone 2023; 168:116668. [PMID: 36621542 PMCID: PMC9911371 DOI: 10.1016/j.bone.2022.116668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 12/19/2022] [Accepted: 12/30/2022] [Indexed: 01/07/2023]
Abstract
OBJECTIVES We assessed skeletal microstructure and stiffness in proton pump inhibitor (PPI) users compared to non-users with high resolution peripheral quantitative computed tomography (HRpQCT) and microfinite element analysis (μFEA) and other modalities. Relationships between PPI dose/frequency and bone parameters were evaluated. METHODS We cross-sectionally assessed skeletal health in 601 older (≥age 65 years) adults (130 PPI users and 471 non-users) participating in a multi-ethnic population-based study of aging. RESULTS PPI users tended to have more comorbidities and take more medications than non-users. Female PPI users (n = 100) were more likely to be non-Caucasian, shorter with higher BMI, and more likely to have diabetes, lower physical activity and be using anti-depressants and thiazide diuretics compared to non-users (n = 302). Male PPI users (n = 30) were more likely to have liver disease than non-users (n = 169). In women, historical fractures (53.0 % vs. 43.4 %, p = 0.05) and falls (38 % vs. 26.8 %, p = 0.04) tended to be more frequent in PPI users compared to non-users. Number of falls was higher in women reporting daily rather than intermittent PPI use (1.8/year vs. 1.0/year, p < 0.001). In women, there were no differences in any HRpQCT or μFEA parameter. By HRpQCT, covariate-adjusted cortical volumetric bone density (Ct.vBMD) was 4.2 % lower in male PPI users vs. non-users at the tibia (p = 0.04), but this did not result in reduced stiffness. There were no other differences by HRpQCT at the tibia or radius. CONCLUSIONS PPI use was not associated with altered skeletal microstructure or stiffness in elderly men and women. The results do not support a relationship between PPI use and microstructure.
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Affiliation(s)
- Ananya Kondapalli
- Division of Endocrinology, Department of Medicine, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Sanchita Agarwal
- Division of Endocrinology, Department of Medicine, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Carmen Germosen
- Division of Endocrinology, Department of Medicine, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Mariana Bucovsky
- Division of Endocrinology, Department of Medicine, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Ivelisse Colon
- Division of Endocrinology, Department of Medicine, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Nayoung Kil
- Division of Endocrinology, Department of Medicine, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Marcella Walker
- Division of Endocrinology, Department of Medicine, Columbia University Irving Medical Center, New York, NY 10032, USA.
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Is there an association between proton pump inhibitors and radiomorphometric parameters of the mandible? A preliminary study. Oral Radiol 2022; 38:586-593. [PMID: 35119594 DOI: 10.1007/s11282-022-00593-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 01/19/2022] [Indexed: 10/19/2022]
Abstract
OBJECTIVES This study aimed to analyze the association between the use of proton pump inhibitors (PPIs) and radiomorphometric parameters of trabecular and cortical bone of the mandible. METHODS A total of 64 patients (37 females and 27 males) using PPIs (PPI group) and 64 age- and gender-matched healthy individuals (control group) were included in this study. The analyzed radiomorphometric parameters were fractal dimension (FD), mandibular cortical width (MCW), and mandibular cortical index (MCI). RESULTS There were no significant differences in the mean FDs of selected regions and MCW between the two groups (p > 0.05). The mean MCW was 1.95 mm in the PPI group and 2 mm in the control group. The MCI C3 category, which represents the most porous state of the mandibular cortex, was 2.5 times more frequent in the PPI group (p = 0.002). PPI use duration did not correlate with FD or MCW. No significant differences were observed in FD, MCW, and MCI distribution according to PPI type (p > 0.05). CONCLUSIONS Although not all radiomorphometric parameters indicated osteoporotic effects of PPI use, the mandibular cortex of PPI users is prone to erosive defects.
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Patel N, Fayed M, Faldu P, Maroun W, Chandarana J. Chronic Proton-Pump Inhibitor Therapy and Fracture Risk in Women Aged Between 50 and 65 years: A Retrospective Case-Control Study. Cureus 2022; 14:e28429. [PMID: 36176864 PMCID: PMC9512296 DOI: 10.7759/cureus.28429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2022] [Indexed: 11/29/2022] Open
Abstract
Introduction Chronic proton-pump inhibitor (PPI) prescription is on the rise in the last decade with an increased prevalence in the elderly population. For most patients, this class of drugs is the primary treatment for various diseases. Even though PPIs are generally safe, long-term use has been associated with multiple adverse effects like bone fractures. The extent of the association between PPI and fracture is still unclear in women aged between 50 and 65 years. Besides, many other variables and risk factors must be accounted for in the analysis of this relation. Methods This is a retrospective case-control study looking at women 50-65 years of age who presented to Genesys Health for a low-impact fall. Data were extracted from electronic medical records and fracture outcomes; PPI therapy exposure and duration were determined. Chi-square analysis was performed to determine the association between chronic PPI therapy and fracture outcome and independently analyzed for major risk factors of osteoporosis, including smoking, low body mass index, and cancer. Results Patients in the chronic PPI therapy group were found to have a decreased fracture outcome overall in each subcategory of risk factors. When adjusting for all risk factors, there was a significant but weak association between chronic PPI therapy and increased fracture outcome. Conclusion With different results from previous studies, this study sheds new light on this debate. More studies need to be carried out to determine the association between chronic PPI therapy and fracture outcomes in postmenopausal women.
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Coşgunarslan A, Canger EM, Soydan Çabuk D. Proton pump inhibitors and mandibular bone quality: A preliminary study. Dentomaxillofac Radiol 2021; 50:20200505. [PMID: 33544631 DOI: 10.1259/dmfr.20200505] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES Proton pump inhibitors (PPI) provide a long-lasting anti-acidic effect by inhibiting the proton pump, and they are one of the most commonly prescribed drugs worldwide. PPIs adversely affect the bone structure via deficiency of vitamins and minerals. The aim of this study was to investigate the possible PPI-induced bone changes in the mandible on panoramic radiographs with the methods of fractal analysis and panoramic morphometric indices. METHODS Panoramic radiographs of 402 patients were used (201 PPI users, 201 control group). Fractal analysis was performed on 4 regions of interests (ROI): 1- upper part of the ramus, 2- angulus, 3- anterior of the mental foramen, 4- distal of the middle ramus. Also, the panoramic mandibular index (PMI), mandibular cortical width (MCW), and Klemetti index (KI) were performed on radiographs. RESULTS There were significant differences in terms of ROI3, MCW, and KI between the control and study groups (p < 0.05) while there was no significant difference for ROI1, ROI2, ROI4, and PMI (p > 0.05). Males were severely affected than females. CONCLUSIONS Osteoporotic changes were detected in the trabecular and cortical bone in the mental foramen region in PPI users with fractal analysis and morphometric indices, while there were no differences for mandibular ramus and angulus regions according to fractal analysis.
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Affiliation(s)
| | - Emin Murat Canger
- Department of Oral and Maxillofacial Radiology, Erciyes University Faculty of Dentistry, Kayseri, Turkey
| | - Damla Soydan Çabuk
- Department of Oral and Maxillofacial Radiology, Çukurova University Faculty of Dentistry, Adana, Turkey
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Do patients with gastroesophageal reflux disease exhibit compromised bone quality prior to proton pump inhibitor therapy? Bone Rep 2021; 14:101095. [PMID: 34095362 PMCID: PMC8167151 DOI: 10.1016/j.bonr.2021.101095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 05/15/2021] [Accepted: 05/18/2021] [Indexed: 11/24/2022] Open
Abstract
Patients with gastroesophageal reflux disease (GERD) are routinely treated with proton pump inhibitors (PPIs), despite many reports of increased fracture risk associated with PPI use. Notably, the skeletal properties in patients with GERD prior to PPI therapy have not been addressed. We hypothesized that PPI-naïve GERD patients have bone impairment, and that short-term treatment with PPI has minimal skeletal effects. To test this, 17 (12 men/5 women) GERD patients age 32–73 years, not previously exposed to PPI, and 17 age- and sex-matched controls were enrolled from September 2010 to December 2012. Bone mineral density (BMD) at lumbar spine, femoral neck, total hip, and trabecular bone score (TBS) at the lumbar spine, a marker of bone microarchitecture, were measured by dual X-ray absorptiometry. Markers of bone turnover and calcium homeostasis, and gastric hormones were analyzed. The same parameters were measured after three months of treatment with the PPI pantoprazole. The GERD patients displayed a significantly lower TBS at baseline than controls (1.31 ± 0.11 vs. 1.43 ± 0.07, p = 0.0006). Total hip and femoral neck BMD were lower in patients compared to controls, however, not significantly (p = 0.09 and 0.12, respectively). CTX was non-significantly higher in GERD patients at baseline (p = 0.11). After three months, changes in BMD, TBS and CTX did not differ between the groups. In conclusion, this is the first report demonstrating compromised bone quality and inferior BMD in PPI-naïve GERD patients. Treatment with pantoprazole did not influence bone parameters, indicating that short-term use with this PPI is safe for the skeleton. Previous studies have reported an increased fracture risk in PPI users. Patients with GERD had compromised bone quality before starting PPI. Three months treatment with pantoprazole did not influence bone parameters.
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Briganti SI, Naciu AM, Tabacco G, Cesareo R, Napoli N, Trimboli P, Castellana M, Manfrini S, Palermo A. Proton Pump Inhibitors and Fractures in Adults: A Critical Appraisal and Review of the Literature. Int J Endocrinol 2021; 2021:8902367. [PMID: 33510787 PMCID: PMC7822697 DOI: 10.1155/2021/8902367] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 12/30/2020] [Accepted: 01/05/2021] [Indexed: 12/11/2022] Open
Abstract
Despite the large number of patients worldwide being on proton pump inhibitors (PPIs) for acid-related gastrointestinal disorders, uncertainty remains over their long-term safety. Particularly, the potential side effects of these drugs on bone health have been evaluated in the last years. The purpose of our narrative review is to gather and discuss results of clinical studies focusing on the interactions between PPIs and fracture risk. Data generated mainly from nested case-control studies and meta-analysis suggest that long-term/high-dose PPIs users are characterized by an increased risk of fragility fractures, mainly hip fractures. However, in these studies, the PPIs-induced bone impairment is often not adjusted for different confounding variables that could potentially affect bone health, and exposure to PPIs was reported using medical prescriptions without adherence evaluation. The mechanisms of the PPI-related bone damage are still unclear, but impaired micronutrients absorption, hypergastrinemia, and increased secretion of histamine may play a role. Clinicians should pay attention when prescribing PPIs to subjects with a preexistent high risk of fractures and consider antiosteoporotic drugs to manage this additive effect on the bone. However, further studies are needed to clarify PPIs action on the bone.
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Affiliation(s)
| | - Anda Mihaela Naciu
- Unit of Endocrinology and Diabetes, University Campus Bio-Medico, Rome, Italy
| | - Gaia Tabacco
- Unit of Endocrinology and Diabetes, University Campus Bio-Medico, Rome, Italy
| | - Roberto Cesareo
- Unit of Metabolic Diseases, Department of Internal Medicine, S. Maria Goretti Hospital, 04100 Latina, Italy
| | - Nicola Napoli
- Unit of Endocrinology and Diabetes, University Campus Bio-Medico, Rome, Italy
| | - Pierpaolo Trimboli
- Scienza Biomediche, Università Della Svizzera Italiana (USI), Lugano, Switzerland
| | - Marco Castellana
- Population Health Unit, National Institute of Gastroenterology “Saverio de Bellis”, Research Hospital, Bari, Italy
| | - Silvia Manfrini
- Unit of Endocrinology and Diabetes, University Campus Bio-Medico, Rome, Italy
| | - Andrea Palermo
- Unit of Endocrinology and Diabetes, University Campus Bio-Medico, Rome, Italy
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Khojah Q, AlRumaihi S, AlRajeh G, Aburas A, AlOthman A, Ferwana M. Vitamin A and its dervatives effect on bone mineral density, a systematic review. J Family Med Prim Care 2021; 10:4089-4095. [PMID: 35136772 PMCID: PMC8797105 DOI: 10.4103/jfmpc.jfmpc_663_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 07/06/2021] [Accepted: 07/09/2021] [Indexed: 11/04/2022] Open
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Aleraij S, Alhowti S, Ferwana M, Abdulmajeed I. Effect of proton pump inhibitors on bone mineral density: A systematic review and meta-analysis of observational studies. Bone Rep 2020; 13:100732. [PMID: 33299906 PMCID: PMC7701953 DOI: 10.1016/j.bonr.2020.100732] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Revised: 09/10/2020] [Accepted: 11/03/2020] [Indexed: 02/07/2023] Open
Abstract
Despite the fact that proton pump inhibitors (PPIs) are one of the most prescribed medications, several epidemiological studies have reported many adverse effects related to their long-term usage. Nevertheless, there were inconsistent findings in the literature with regard to PPI use and bone mineral density (BMD) change. The aim of this systematic review and meta-analysis is to evaluate the association between the use of PPIs and change in BMD. The PubMed/MEDLINE, EMBASE, Cochrane and CINAHL databases were searched up to March 2019. Ten studies fulfilled the eligibility criteria (4761 cases and 30,809 controls), from which the mean difference and mean annualized percent change in BMD were pooled using RevMan 5.3.5 The results showed no statistically significant association between PPI users and non-users in mean annualized percent change in BMD (0.06; 95% CI -0.07, 0.18) with moderate heterogeneity (I2: 63%). There was a statistically significant reduction in the mean BMD difference among PPI users (-0.03; 95% CI -0.04, -0.01) with no substantial heterogeneity (I2: 26%). This meta-analysis reported inconsistent results regarding the use of PPIs and BMD loss. Thus, the effect of PPIs on BMD needs to be elucidated by other studies, and healthcare providers should prescribe PPIs with caution considering their unfavorable consequences on bone health.
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Affiliation(s)
- Sara Aleraij
- Department of Family Medicine and PHC, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia
| | - Sultan Alhowti
- Department of Family Medicine and PHC, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia
| | - Mazen Ferwana
- Department of Family Medicine and PHC, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia
- National and Gulf Center for Evidence Based Health Practices, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Imad Abdulmajeed
- Department of Family Medicine and PHC, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia
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Min YW, Lee YC, Kim K, Ryu S, Hong KS, Jeon HH, Kim YS, Park JH, Son HJ, Rhee PL. Proton pump inhibitor use is associated with hip fracture development: a nationwide population-based cohort study. Korean J Intern Med 2020; 35:1084-1093. [PMID: 31671930 PMCID: PMC7487306 DOI: 10.3904/kjim.2018.331] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 11/13/2018] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND/AIMS Effect of proton pump inhibitor (PPI) use on the risk of hip fracture is controversial. This study aimed to clarify the association between PPI use and hip fracture risk using a large cohort. METHODS This study recruited participants from the nationwide cohort (n = 1,025,340). After exclusion of participants who had hip fractures or were aged less than 40 years during the baseline period (2002 to 2004), 371,806 participants were followed to 2013. Participants prescribed PPIs for more than 90 days during baseline period were defined as users. Fracture cases were defined when participants were hospitalized with claims of a hip fracture. RESULTS During 4,159,343 person-years of follow-up, fractures developed more often in PPI users than in nonusers (relative risk [RR], 1.787; 95% confidence interval [CI], 1.260 to 2.534; p = 0.002). The results persisted after adjusting for age, sex, and many drugs relevant to osteoporosis or influential in bone health. Furthermore, fracture risk associated with PPI use increased with duration of use (p trend < 0.001). The fully adjusted RRs of hip fracture development were 1.350 (95% CI, 1.203 to 1.515) for 1- to 90-day users, 1.487 (95% CI, 0.957 to 2.311) for 91- to 180-day users, and 1.771 (95% CI, 0.931 to 3.368) for > 180-day users. The positive association between PPI use and fracture was also confirmed in a subgroup with health screening data where further adjustment for body mass index, smoking status, alcohol consumption, and physical activity was available (adjusted RR, 2.025; 95% CI, 1.151 to 3.564, p = 0.014). CONCLUSION PPI use is associated with hip fracture development.
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Affiliation(s)
- Yang Won Min
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yeong Chan Lee
- Department of Digital Health, Samsung Advanced Institute for Health Science and Technology, Sungkyunkwan University, Seoul, Korea
| | - Kyunga Kim
- Department of Digital Health, Samsung Advanced Institute for Health Science and Technology, Sungkyunkwan University, Seoul, Korea
- Statistics and Data Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Korea
| | - Seungho Ryu
- Department of Occupational and Environmental Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University, Seoul, Korea
- Department of Clinical Research Design and Evaluation, Samsung Advanced Institute for Health Science and Technology, Sungkyunkwan University School of Medicine, Seoul, Korea
- Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyoung Sub Hong
- Department of Gastroenterology, Mediplex Sejong Hospital, Incheon, Korea
| | - Han Ho Jeon
- Division of Gastroenterology, Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Ilsan, Korea
| | - Yong Sung Kim
- Department of Gastroenterology, Wonkwang Digestive Disease Research Institute, Wonkwang University Sanbon Hospital, Gunpo, Korea
| | - Jong Heon Park
- Big Data Steering Department, National Health Insurance Service, Wonju, Korea
| | - Hee Jung Son
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Hee Jung Son, M.D. Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Korea Tel: +82-2-3410-3409, Fax: +82-2-3410-6983, E-mail:
| | - Poong-Lyul Rhee
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Correspondence to Poong-Lyul Rhee, M.D. Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Korea Tel: +82-2-3410-3409, Fax: +82-2-3410-6983, E-mail:
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RE: The Beers Criteria: Not just for geriatrics anymore? Analysis of beers criteria medications in nongeriatric trauma patients and their association with falls. J Trauma Acute Care Surg 2020; 88:e120. [DOI: 10.1097/ta.0000000000002513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Kavookjian H, Irwin T, Garnett JD, Kraft S. The Reflux Symptom Index and Symptom Overlap in Dysphonic Patients. Laryngoscope 2020; 130:2631-2636. [PMID: 32027383 DOI: 10.1002/lary.28506] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 12/23/2019] [Accepted: 12/30/2019] [Indexed: 12/12/2022]
Abstract
OBJECTIVES/HYPOTHESIS The Reflux Symptom Index (RSI) is a validated quality-of-life instrument that quantifies symptoms associated with laryngopharyngeal reflux (LPR). Many dysphonic patients are managed empirically for reflux. In this study, we examine responses to the RSI in patients with dysphonia attributable to a variety of pathologies. STUDY DESIGN Retrospective cohort study. METHODS This is an institutional review board-approved study. All patients presented to a tertiary care voice center January 2011 to June 2016 with the chief complaint of dysphonia. Patients were analyzed by 1) diagnosis and 2) treatment modality: surgery, medicine, or voice therapy (VT). Data collected included pre- and postintervention RSI and Voice Handicap Index, demographic, and clinical information. Statistical analysis was performed using SPSS. RESULTS Five hundred forty-six dysphonic patients were included. One hundred forty required surgery, 155 were treated with VT alone, and 251 were medically managed (MM). Prior to therapy, 63.4% of surgery patients, 62.5% of VT patients, and 74.6% of MM patients had an abnormal RSI with a score greater than 13. The most common diagnosis for each group was vocal cord paresis/paralysis (surgery), vocal fold atrophy (VT), and LPR (MM). There was a statistically significant improvement in RSI after treatment for each group. CONCLUSIONS In patients with dysphonia, pretreatment RSI scores were elevated for a variety of laryngeal pathologies. Scores often improved with directed treatment, regardless of etiology. This highlights the symptom overlap between reflux and nonreflux causes of dysphonia, and the importance of a comprehensive workup for patients with voice complaints. LEVEL OF EVIDENCE 4 Laryngoscope, 130:2631-2636, 2020.
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Affiliation(s)
- Hannah Kavookjian
- Department of Otolaryngology, University of Kansas Medical Center, Kansas City, Missouri, U.S.A
| | - Thomas Irwin
- Department of Otolaryngology, University of Kansas Medical Center, Kansas City, Missouri, U.S.A
| | - James D Garnett
- Department of Otolaryngology, University of Kansas Medical Center, Kansas City, Missouri, U.S.A
| | - Shannon Kraft
- Department of Otolaryngology, University of Kansas Medical Center, Kansas City, Missouri, U.S.A
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Hoff M, Skovlund E, Skurtveit S, Meyer HE, Langhammer A, Søgaard AJ, Syversen U, Forsmo S, Abrahamsen B, Schei B. Proton pump inhibitors and fracture risk. The HUNT study, Norway. Osteoporos Int 2020; 31:109-118. [PMID: 31741023 DOI: 10.1007/s00198-019-05206-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 10/22/2019] [Indexed: 12/16/2022]
Abstract
UNLABELLED Proton pump inhibitors (PPIs) have been linked to increased risk of fracture; the data have, however, been diverging. We did not find any increased risk of fractures among users of PPIs in a Norwegian population of 15,017 women and 13,241 men aged 50-85 years with detailed information about lifestyle and comorbidity. INTRODUCTION Proton pump inhibitors (PPIs) are widely prescribed and have been linked to increased risk of fracture. METHODS We used data from the Nord-Trøndelag Health Study (HUNT3), The Fracture registry in Nord-Trøndelag, and the Norwegian Prescription Database, including 15,017 women and 13,241 men aged 50-85 years. The study population was followed from the date of participating in HUNT3 (2006-2008) until the date of first fracture (forearm or hip), death, or end of study (31 December 2012). The Cox proportional hazards model with time-dependent exposure to PPIs was applied, and each individual was considered as unexposed until the first prescriptions was filled. To be included, the prescription of PPIs should minimum be equivalent to 90 defined daily doses (DDD) in the period. Individuals were defined as exposed until 6 months after end of drug supply. RESULTS The proportion of women and men using PPIs was 17.9% and 15.5%, respectively. During a median of 5.2 years follow-up, 266 women and 134 men had a first hip fracture and 662 women and 127 men, a first forearm fracture. The combined rate/1000 patient-years for forearm and hip fractures in women was 49.2 for users of PPIs compared with 64.1 among non-users; for men 18.6 and 19.8, respectively. The hazard ratios with 95% confidence interval for the first forearm or hip fracture among users of PPIs in the age-adjusted analysis were 0.82 (0.67-1.01) for women and 1.05 (0.72-1.52) for men. Adjusting for age, use of anti-osteoporotic drugs, and FRAX, the HR declined to 0.80 (0.65-0.98) in women and 1.00 (0.69-1.45) in men. CONCLUSIONS Use of PPIs was not associated with an increased risk of fractures.
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Affiliation(s)
- M Hoff
- Department of Public Health and Nursing, Norwegian University of Science and Technology, PB 8905, 7491, Trondheim, Norway.
- Department of Rheumatology, St Olavs Hospital, Trondheim, Norway.
| | - E Skovlund
- Department of Public Health and Nursing, Norwegian University of Science and Technology, PB 8905, 7491, Trondheim, Norway
- Norwegian Institute of Public Health, Oslo, Norway
| | - S Skurtveit
- Norwegian Institute of Public Health, Oslo, Norway
- Norwegian Centre for Addiction Research, University of Oslo, Oslo, Norway
| | - H E Meyer
- Norwegian Institute of Public Health, Oslo, Norway
- Department of Community Medicine and Global Health, University of Oslo, Oslo, Norway
| | - A Langhammer
- Department of Public Health and Nursing, Norwegian University of Science and Technology, PB 8905, 7491, Trondheim, Norway
| | - A J Søgaard
- Norwegian Institute of Public Health, Oslo, Norway
| | - U Syversen
- Department of Endocrinology, St. Olavs Hospital, Trondheim, Norway
- Department of Clinical and and Molecular Medicine, NTNU, Trondheim, Norway
| | - S Forsmo
- Department of Public Health and Nursing, Norwegian University of Science and Technology, PB 8905, 7491, Trondheim, Norway
| | - B Abrahamsen
- Department of Medicine, Holbæk Hospital, Holbæk, Denmark
- Odense Patient Data Explorative Network, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - B Schei
- Department of Public Health and Nursing, Norwegian University of Science and Technology, PB 8905, 7491, Trondheim, Norway
- Department of Gynecology, St Olavs Hospital, Trondheim, Norway
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Thong BKS, Ima-Nirwana S, Chin KY. Proton Pump Inhibitors and Fracture Risk: A Review of Current Evidence and Mechanisms Involved. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E1571. [PMID: 31060319 PMCID: PMC6540255 DOI: 10.3390/ijerph16091571] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 04/25/2019] [Accepted: 04/30/2019] [Indexed: 12/11/2022]
Abstract
The number of patients with gastroesophageal problems taking proton pump inhibitors (PPIs) is increasing. Several studies suggested a possible association between PPIs and fracture risk, especially hip fractures, but the relationship remains contentious. This review aimed to investigate the longitudinal studies published in the last five years on the relationship between PPIs and fracture risk. The mechanism underlying this relationship was also explored. Overall, PPIs were positively associated with elevated fracture risk in multiple studies (n = 14), although some studies reported no significant relationship (n = 4). Increased gastrin production and hypochlorhydria are the two main mechanisms that affect bone remodeling, mineral absorption, and muscle strength, contributing to increased fracture risk among PPI users. As a conclusion, there is a potential relationship between PPIs and fracture risks. Therefore, patients on long-term PPI treatment should pay attention to bone health status and consider prophylaxis to decrease fracture risk.
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Affiliation(s)
- Benjamin Ka Seng Thong
- Department of Pharmacology, Universiti Kebangsaan Malaysia Medical Centre, Cheras 56000, Malaysia.
| | - Soelaiman Ima-Nirwana
- Department of Pharmacology, Universiti Kebangsaan Malaysia Medical Centre, Cheras 56000, Malaysia.
| | - Kok-Yong Chin
- Department of Pharmacology, Universiti Kebangsaan Malaysia Medical Centre, Cheras 56000, Malaysia.
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Nassar Y, Richter S. Proton-pump Inhibitor Use and Fracture Risk: An Updated Systematic Review and Meta-analysis. J Bone Metab 2018; 25:141-151. [PMID: 30237993 PMCID: PMC6135649 DOI: 10.11005/jbm.2018.25.3.141] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 06/30/2018] [Accepted: 07/06/2018] [Indexed: 02/07/2023] Open
Abstract
Background This study's objective was to evaluate the association between proton-pump inhibitor (PPI) use and bone fracture incidence and bone mineral density (BMD) by meta-analyzing the estimates reported by epidemiological and cohort studies. Methods Data were acquired from studies identified after a literature search in electronic databases. Odds ratios (ORs), hazard ratios (HRs), and risk ratios (RRs) between PPI use and bone fracture incidence were pooled under the random effects model, and meta-analysis of standardized mean differences between PPI users and controls in cross-sectional values and BMD changes was conducted. Results Thirty-three studies fulfilled the eligibility criteria. These studies provided data from 2,714,502 individuals with a mean age of 66.91 years (95% confidence interval [CI], 63.37–70.46); 33.21% (95% CI, 30.44–35.99) were males and 64.61% (95% CI, 60.73–68.49) were females. Overall, fracture incidence was 22.04% (95% CI, 16.10–27.97) in PPI users and 15.57% (95% CI, 12.28–18.86) in controls. The overall effect size of the point estimate was 1.28 (95% CI, 1.22–1.35) between PPI use and bone fracture incidence. There was a trend towards increased fracture incidence from short duration use: OR 1.29 (95% CI, 1.19–1.40), medium duration use: OR 1.33 (95% CI, 1.12–1.55) and long duration use: OR 1.62 (95% CI, 1.33–1.90). There was no significant difference in the standardized mean differences between PPI users and controls, either in cross-sectional BMD values or in the BMD change observed in longitudinal studies. Conclusions Pooling of ORs, HRs, and RRs suggested that PPI use might increase fracture risk. However, there was no effect of PPI use on BMD.
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Affiliation(s)
- Yousef Nassar
- Department of Medicine, Albany Medical Center, Albany, New York, USA
| | - Seth Richter
- Department of Medicine, Albany Medical Center, Albany, New York, USA
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Varela A, Jolette J. Bone Toolbox: Biomarkers, Imaging Tools, Biomechanics, and Histomorphometry. Toxicol Pathol 2018; 46:511-529. [PMID: 29973125 DOI: 10.1177/0192623318779565] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Bone is a unique tissue with turnover, metabolic, and cellular activities that vary through development to aging and with a mineralized matrix in which the current state and the history of a bone coexist. Qualitative histopathology often lacks sensitivity to detect changes in bone formation, mineralization and resorption, which often requires chronic dosing to result in structural changes such as variation in bone mass and geometry. A large panel of modalities can be used to fully analyze the health of the skeleton, including biomarker evaluation in serum or urine, imaging techniques ranging from radiology to computed tomography, biomechanical testing, and undecalcified tissue processing with bone histomorphometry. The use of clinically relevant biomarkers provides an important noninvasive, sensitive, rapid, and real-time tool to monitor bone activity at the whole skeleton level when conducting safety assessments in a preclinical setting. Imaging modalities also allow in vivo longitudinal assessments with a powerful, noninvasive and clinically translatable tools to monitor drug effects. Different imaging modalities are used in the preclinical studies to evaluate the bone tissues: standard radiography, dual-energy X-ray absorptiometry, peripheral quantitative computed tomography (pQCT), micro-computed tomography, and high-resolution pQCT. Bone histomorphometry is an important tool that provides sensitive evaluation to detect effects of test articles on bone resorption, formation, mineralization, remodeling rates and growth to address a potential target- or class-related theoretical bone liability. Ultimately, the measurement of bone mechanical properties in pharmaceutical testing is critical to understand the potential effects of that pharmaceutical on bone health and fracture risk. Important considerations are required for including these different techniques in toxicology rodents and nonrodent studies, to actually integrate these into safety assessment.
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Affiliation(s)
- Aurore Varela
- 1 Charles River Laboratories Montreal ULC, Senneville, Quebec, Canada
| | - Jacquelin Jolette
- 1 Charles River Laboratories Montreal ULC, Senneville, Quebec, Canada
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Qorraj-Bytyqi H, Hoxha R, Sadiku S, Bajraktari IH, Sopjani M, Thaçi K, Thaçi S, Bahtiri E. Proton Pump Inhibitors Intake and Iron and Vitamin B12 Status: A Prospective Comparative Study with a Follow up of 12 Months. Open Access Maced J Med Sci 2018; 6:442-446. [PMID: 29610598 PMCID: PMC5874363 DOI: 10.3889/oamjms.2018.142] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 02/20/2018] [Accepted: 02/28/2018] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Proton pump inhibitors (PPIs) represent the most widely prescribed antisecretory agents, but their prolonged use, may influence iron and vitamin B12 status, which could have important implications for clinical practice. AIM We undertook this study aiming to investigate the association between PPIs use for 12 months and potential changes in iron and vitamin B12 status, as well as whether this potential association varies among four specific PPI drugs used in the study. METHODS A total of 250 adult subjects were recruited into this study, of which 200 subjects were PPIs users while 50 subjects belonged to the control group. Serum iron, ferritin, vitamin B12, and homocysteine (Hcy) levels were measured before the start of the study and after 12 months. Mann - Whitney U test and Kruskal - Wallis test was used to compare the baseline characteristics of the study groups, while Wilcoxon test was used to analyse post - pre differences. RESULTS Statistical analysis showed significant changes within PPIs group and specific PPIs subgroups between the two-time points in serum ferritin and vitamin B12 levels, respectively, while no significant changes in serum iron and homocysteine levels were shown. However, subsequent diagnosis of hypoferremia and hypovitaminosis B12 in the whole study sample at 12 months was established in only 3.8% and 2.9% of the subjects, respectively. CONCLUSION PPIs use for 12 months did not result in clinically significant iron and/or vitamin B12 deficiency; thus, these findings argue routine screening under normal circumstances, although monitoring in elderly and malnourished may be of precious value.
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Affiliation(s)
- Hasime Qorraj-Bytyqi
- Department of Pharmacology, Faculty of Medicine, University of Prishtina, Prishtina, Kosovo
| | - Rexhep Hoxha
- Department of Pharmacology, Faculty of Medicine, University of Prishtina, Prishtina, Kosovo
| | - Shemsedin Sadiku
- Clinic of Hematology, University Clinical Center of Kosovo, Prishtina, Kosovo
| | - Ismet H Bajraktari
- Clinic of Rheumatology, University Clinical Center of Kosovo, Prishtina, Kosovo
| | - Mentor Sopjani
- Department of Preclinical Studies, Faculty of Medicine, University of Prishtina, Kosovo
| | - Kujtim Thaçi
- Institute of Biochemistry, University Clinical Center of Kosovo, Prishtina, Kosovo
| | - Shpetim Thaçi
- Department of Preclinical Studies, Faculty of Medicine, University of Prishtina, Kosovo
| | - Elton Bahtiri
- Department of Pharmacology, Faculty of Medicine, University of Prishtina, Prishtina, Kosovo.,Clinic of Endocrinology, University Clinical Center of Kosovo, Prishtina, Kosovo
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Krasniqi E, Koni M, Tschan H, Krasniqi B, Kabashi A, Boshnjaku A. Musculoskeletal Health of 40-65 Year Old Males and Females in Kosova and the Impact of N05B, A02B (PPI, H2RA), H02AB and Lifestyle Factors on It. Med Arch 2016; 70:359-363. [PMID: 27994297 PMCID: PMC5136431 DOI: 10.5455/medarh.2016.70.359-363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2016] [Accepted: 10/11/2016] [Indexed: 11/30/2022] Open
Abstract
Background: This observational, cross-sectional study investigates the impact of medication usage, physical activity (PA) and nutritional status on musculoskeletal health (MSH) in males and females aged 40-65 in the population of a post conflict, developing country. Methods: Bone Mineral Density (BMD), T-score and Z-score at distal forearm regions (measured by DEXA scan), together with isometric hand grip strength (dynamometer) were evaluated in a total of 162 subjects (53 Males, average age 55.15±7.12 and 109 Females, 54.27±5.1). Additionally, bio-anthropometric assessments, medication usage, PA level and nutritional status were assessed. Results: Significant differences (p<0.05) were found in total subjects Body Mass Index (BMI), PA, BMD, T-score and Hand grip between genders. 42% of total participants met the diagnostic criteria of, out of which 6.8% with T-score below -2, while no cases of Osteoporosis was recorded. N05B Anxiolytics and A02B Drugs for peptic ulcer and gastro-oesophageal reflux disease medication groups consumption turned to have no significant differences (p>0.05) in BMD, T-score, and hand grip in total population, except for A02B where p<0.05 were found in Hand grip, as well as between female consumers and no consumers in all variables. Meanwhile, in total subjects consuming H02AB Glucocorticoids p<0.05 were observed in BMD and T-score, but not on hand grip. Conclusions: This study shows a low risk for MSH problems amongst the studied population in Kosova, while the consumption of H02AB medication group in both genders and A02B in females only for extended periods might effect MSH, therefore appropriate benefit/risk assessment should be made before prescribing these medications, notwithstanding age, gender, PA or nutritional status.
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Affiliation(s)
- Ermira Krasniqi
- Medical University of Tirana, Faculty of Medical Technical Sciences, Tirana, Albania; Medical Sciences College Rezonanca, Prishtinë, Kosovo
| | - Mynyr Koni
- Medical University of Tirana, Faculty of Medical Technical Sciences, Tirana, Albania; University of Tirana, Faculty of Natural Sciences, Tirana, Albania
| | - Harald Tschan
- University of Vienna, Faculty of Natural Sciences/Life Sciences, Vienna, Austria
| | | | - Antigona Kabashi
- Medical University of Tirana, Faculty of Medical Technical Sciences, Tirana, Albania
| | - Arben Boshnjaku
- University of Vienna, Faculty of Natural Sciences/Life Sciences, Vienna, Austria
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Aasarød KM, Ramezanzadehkoldeh M, Shabestari M, Mosti MP, Stunes AK, Reseland JE, Beisvag V, Eriksen EF, Sandvik AK, Erben RG, Schüler C, Boyce M, Skallerud BH, Syversen U, Fossmark R. Skeletal effects of a gastrin receptor antagonist in H+/K+ATPase beta subunit KO mice. J Endocrinol 2016; 230:251-62. [PMID: 27325243 DOI: 10.1530/joe-16-0017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 06/20/2016] [Indexed: 12/15/2022]
Abstract
Epidemiological studies suggest an increased fracture risk in patients taking proton pump inhibitors (PPIs) for long term. The underlying mechanism, however, has been disputed. By binding to the gastric proton pump, PPIs inhibit gastric acid secretion. We have previously shown that proton pump (H(+)/K(+)ATPase beta subunit) KO mice exhibit reduced bone mineral density (BMD) and inferior bone strength compared with WT mice. Patients using PPIs as well as these KO mice exhibit gastric hypoacidity, and subsequently increased serum concentrations of the hormone gastrin. In this study, we wanted to examine whether inhibition of the gastrin/CCK2 receptor influences bone quality in these mice. KO and WT mice were given either the gastrin/CCK2 receptor antagonist netazepide dissolved in polyethylene glycol (PEG) or only PEG for 1year. We found significantly lower bone mineral content and BMD, as well as inferior bone microarchitecture in KO mice compared with WT. Biomechanical properties by three-point bending test also proved inferior in KO mice. KO mice receiving netazepide exhibited significantly higher cortical thickness, cortical area fraction, trabecular thickness and trabecular BMD by micro-CT compared with the control group. Three-point bending test also showed higher Young's modulus of elasticity in the netazepide KO group compared with control mice. In conclusion, we observed that the gastrin receptor antagonist netazepide slightly improved bone quality in this mouse model, suggesting that hypergastrinemia may contribute to deteriorated bone quality during acid inhibition.
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Affiliation(s)
- Kristin M Aasarød
- Department of Cancer Research and Molecular MedicineNTNU, Trondheim, Norway
| | | | - Maziar Shabestari
- Department of BiomaterialsInstitute of Clinical Dentistry, University of Oslo, Oslo, Norway
| | - Mats P Mosti
- Department of Cancer Research and Molecular MedicineNTNU, Trondheim, Norway
| | - Astrid K Stunes
- Department of Cancer Research and Molecular MedicineNTNU, Trondheim, Norway
| | - Janne E Reseland
- Department of BiomaterialsInstitute of Clinical Dentistry, University of Oslo, Oslo, Norway
| | - Vidar Beisvag
- Department of Cancer Research and Molecular MedicineNTNU, Trondheim, Norway
| | | | - Arne K Sandvik
- Department of Cancer Research and Molecular MedicineNTNU, Trondheim, Norway Department of Gastroenterology and HepatologySt. Olav's Hospital, Trondheim, Norway Centre of Molecular Inflammation ResearchNTNU, Trondheim, Norway
| | - Reinhold G Erben
- Department of Biomedical SciencesUniversity of Veterinary Medicine Vienna, Vienna, Austria
| | - Christiane Schüler
- Department of Biomedical SciencesUniversity of Veterinary Medicine Vienna, Vienna, Austria
| | | | | | - Unni Syversen
- Department of Cancer Research and Molecular MedicineNTNU, Trondheim, Norway Department of EndocrinologySt. Olav's Hospital, Trondheim, Norway
| | - Reidar Fossmark
- Department of Cancer Research and Molecular MedicineNTNU, Trondheim, Norway Department of Gastroenterology and HepatologySt. Olav's Hospital, Trondheim, Norway
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Aasarød KM, Mosti MP, Stunes AK, Reseland JE, Basso T, Syversen U, Fossmark R. Impaired skeletal health in patients with chronic atrophic gastritis. Scand J Gastroenterol 2016; 51:774-81. [PMID: 26854332 DOI: 10.3109/00365521.2016.1141317] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE In chronic atrophic gastritis (CAG), destruction of gastric parietal cells causes anacidity and hypergastrinemia. Use of proton pump inhibitors, which also induces gastric anacidity, is associated with increased fracture rates. Our objectives were to study possible differences in bone mineral density (BMD) and bone quality in patients with CAG compared to controls. MATERIAL AND METHODS We performed a cross-sectional study on 17 CAG patients aged 54 ± 13 years and 41 sex- and age-matched controls. Lumbar and femoral BMD and bone quality assessed by lumbar trabecular bone score (TBS) were measured by DXA, and bone material strength (BMS) by microindentation of the tibia. Serum bone markers (CTX, P1NP, sclerostin, osteocalcin, OPG, RANKL) were analyzed. RESULTS We found lower lumbar BMD Z-score (-0.324 ± 1.096 versus 0.456 ± 1.262, p = 0.030), as well as a higher frequency of osteoporosis at the lumbar spine (p = 0.046) and osteopenia at total hip (p = 0.019) in patients compared to controls. In a post hoc subgroup analysis, we observed that the differences were confined to the male patients. TBS also tended to be lower in male patients (p = 0.059), while BMS did not differ between the groups. Osteocalcin, sclerostin, OPG, and OPG/RANKL ratio were lower in patients compared to controls, while CTX and P1NP did not differ between the groups. CONCLUSIONS We observed lower lumbar BMD, increased frequency of osteopenia and osteoporosis in male, but not female patients with CAG. Bone markers suggest a decrease in bone formation and increased bone resorption in CAG patients compared to controls.
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Affiliation(s)
- Kristin Matre Aasarød
- a Department of Cancer Research and Molecular Medicine , Norwegian University of Science and Technology (NTNU) , Trondheim , Norway ;,b Department of Gastroenterology and Hepatology , St Olav's Hospital , Trondheim , Norway
| | - Mats Peder Mosti
- a Department of Cancer Research and Molecular Medicine , Norwegian University of Science and Technology (NTNU) , Trondheim , Norway
| | - Astrid Kamilla Stunes
- a Department of Cancer Research and Molecular Medicine , Norwegian University of Science and Technology (NTNU) , Trondheim , Norway
| | - Janne Elin Reseland
- c Department of Biomaterials , Institute of Clinical Dentistry, University of Oslo , Norway
| | - Trude Basso
- d Department of Orthopedics , St. Olav's Hospital , Trondheim , Norway ;,e Department of Neuroscience , NTNU , Trondheim , Norway
| | - Unni Syversen
- a Department of Cancer Research and Molecular Medicine , Norwegian University of Science and Technology (NTNU) , Trondheim , Norway ;,f Department of Endocrinology , St. Olav's Hospital , Trondheim , Norway
| | - Reidar Fossmark
- a Department of Cancer Research and Molecular Medicine , Norwegian University of Science and Technology (NTNU) , Trondheim , Norway ;,b Department of Gastroenterology and Hepatology , St Olav's Hospital , Trondheim , Norway
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Arj A, Razavi Zade M, Yavari M, Akbari H, Zamani B, Asemi Z. Proton pump inhibitors use and change in bone mineral density. Int J Rheum Dis 2016; 19:864-8. [DOI: 10.1111/1756-185x.12866] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Abbas Arj
- Department of Gastroenterology; Kashan University of Medical Sciences; Kashan Iran
| | - Mohsen Razavi Zade
- Department of Gastroenterology; Kashan University of Medical Sciences; Kashan Iran
| | - Maryam Yavari
- Department of Gastroenterology; Kashan University of Medical Sciences; Kashan Iran
| | - Hossein Akbari
- Department of Biostatistics; Kashan University of Medical Sciences; Kashan Iran
| | - Batol Zamani
- Department of Autoimmune Diseases Research Center; Kashan University of Medical Sciences; Kashan Iran
- Department of Internal Medicine; Kashan University of Medical Sciences; Kashan Iran
| | - Zatollah Asemi
- Research Center for Biochemistry and Nutrition in Metabolic Diseases; Kashan University of Medical Sciences; Kashan Iran
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