Proton Pump Inhibitor Use Is Not Associated With Osteoporosis or Accelerated Bone Mineral Density Loss
Received 17 March 2009; accepted 12 November 2009. published online 19 November 2009. Uncorrected Proof
Backgrounds & Aims
Recent studies have shown an association between proton pump inhibitor use (PPI) and hip fracture. The mechanism by which PPI use promotes the development of hip fracture is uncharacterized. Therefore, we sought to determine whether PPI use is associated with osteoporosis or accelerated bone mineral density (BMD) loss.
Methods
We used the Manitoba Bone Mineral Density Database to determine the relationship between chronic PPI use and osteoporosis on an initial assessment of BMD and on BMD loss between successive assessments of BMD. In the cross-sectional study, cases with osteoporosis at the hip or lumbar vertebrae (T-score ≤ −2.5) were matched to 3 controls with normal BMD (T-score ≥ −1.0). In the longitudinal analysis, the change in BMD among PPI users and nonusers between successive BMD assessments was assessed. Conditional logistic regression and multivariate linear regression were used to obtain estimates of the association between PPI use and osteoporosis and of the annualized change in BMD associated with PPI use.
Results
PPI use was not associated with having osteoporosis at either the hip (OR, 0.84; 95% CI, 0.55–1.34) or the lumbar spine (OR, 0.79; 95% CI, 0.59–1.06) for PPI use >1500 doses over the previous 5 years. In the longitudinal study no significant decrease was observed in BMD at either site attributable to PPI use.
Conclusions
PPI use does not appear to be associated with either the presence of osteoporosis or accelerated BMD loss. The association between PPI use and hip fracture is probably related to factors independent of osteoporosis.
⁎Section of Gastroenterology, Division of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
‡Manitoba Centre for Health Policy, Department of Community Health Sciences, Faculty of Medicine, Winnipeg, Manitoba, Canada
§School of Public Health, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
∥Section of Nuclear Medicine, Department of Radiology, University of Manitoba, Winnipeg, Manitoba, Canada
¶Section of Endocrinology & Metabolism, Division of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
Reprint requests Address requests for reprints to: Laura Targownik, MD, MSHS, 805G-715 McDermot Avenue, Winnipeg, Manitoba, Canada R3N 0V6.fax: xxx
Conflicts of interest The authors disclose the following: Dr Laura Targownik has served on advisory boards for Janssen-Ortho Canada and Astra-Zeneca Canada and on the speaker's bureau for Astra-Zeneca Canada. Both companies either currently or at one time marketed particular proton pump inhibitors in Canada. The remaining authors disclose no conflicts.
Funding Dr Targownik is supported by a Canadian Institutes of Health Research New Investigator Grant in Osteoporosis, and by Osteoporosis Canada. Dr Leslie is supported by the Canadian Institutes of Health Research. Dr Lix is supported by a CIHR New Investigator Award. This project was funded by a grant from the Canadian Institutes of Health Research Regional Partnership Program and the Manitoba Health Research Council.
ABSTRACT