Effect of long-term proton pump inhibitors on bone mineral density

Tunis Med. 2018 Mar;96(3):193-197.


Background: Proton pump inhibitors (PPIs) are widespread nowadays. Recent concerns haveemerged about possible bone complications of their long-term use, as lowbone mineral density (BMD) and an increased risk of fractures.

Aim: To evaluate the effect of long-term use of PPIs on boneby estimating the frequency of osteopenia andosteoporosis, and determining the risk factors associated to these complications.

Methods: A prospective study including consecutive patients taking PPI for at least one year. All patients underwent bonedensitometry, and FRAXscore was calculated to estimate the risk of osteoporotic fracture.

Results: We included 52 patients with a mean age of 49.5 years and a male-femaleratio of 0,48. Mean duration of PPI intake was 45 months. The most frequentindication was gastroesophageal reflux disease. PPI prescription wasappropriate in 94% of cases. The calculated daily calcium intake was in majority insufficient (94%). Approximately half of patients had at least three risk factors. Osteopenia and osteoporosiswere observed in 52% and 19% respectively. Predictive factors of low BMD were an age≥50 years, menopause, calcium intake ≤550mg/day and a PPI use duration≥30 months. FRAX score was significantly higher when BMD was lower. The multivariate analysis could not be undertaken because of co linearity of the factors.

Conclusion: Long-term PPI use is associated with risk of bone complications, especiallyamong patients at risk for osteoporosis. It seems reasonable to be more vigilantin prescribing PPIs and to use the lowest effective dose for patients with appropriateindications.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Bone Density / drug effects*
  • Bone Diseases, Metabolic / chemically induced
  • Bone Diseases, Metabolic / epidemiology
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Osteoporosis / chemically induced
  • Osteoporosis / epidemiology
  • Osteoporotic Fractures / chemically induced
  • Osteoporotic Fractures / epidemiology
  • Prospective Studies
  • Proton Pump Inhibitors / pharmacology*
  • Proton Pump Inhibitors / therapeutic use*
  • Risk Factors
  • Time Factors


  • Proton Pump Inhibitors