Long-term Use of Proton Pump Inhibitors (PPIs) and Their Effects on Bone Health
Abstract
Dear Editor,
More than 25% of the global population suffer from acid-related disorders such as dyspepsia or GERD.[1] Acid-related disorders are frequently treated with proton pump inhibitors (PPIs). PPIs work by irreversibly inhibiting the H+/K+ ATPase enzyme, thereby reducing gastric acid secretion and regulating acid production. Since being brought to the market in 1989, their use has grown significantly globally, and they are currently among the top ten medications prescribed in the US and Pakistan. Six medications in this class—omeprazole, esomeprazole, lansoprazole, dexlansoprazole, pantoprazole, and rabeprazole—had received FDA approval as of 2015.[2] PPI prescriptions typically last four to eight weeks. However, long-term use may be necessary for patients with comorbidities who require multiple medications.
PPI use should be carefully considered, particularly for patients whose treatment may last for many years and in third-world countries where people may use drugs based on word-of-mouth recommendations rather than prescriptions due to financial instability and illiteracy. Observational and population-based cohort studies have associated long-term PPI use with an increased risk of pneumonia, major cardiovascular events, dementia, vitamin B12 deficiency, bone fractures, gastric cancer, and kidney injury, among other complications.[1] A possible positive correlation between PPIs and osteoporotic fracture risk, including those of the hip, spine, and wrist, has sparked…
How strong is the evidence?
Evidence Hub reads this as a cohort study, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence.
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