The Bone of Contention: Unraveling the Connection Between Proton Pump Inhibitors and Osteoporosis
proton pump inhibitors and osteoporosis

Proton pump inhibitors (PPIs) have long been hailed as the gold standard in treating acid-related disorders such as gastroesophageal reflux disease (GERD), peptic ulcers, and other stomach-acid disorders. However, ongoing research has raised concerns about the potential link between proton pump inhibitors and osteoporosis, a condition characterized by weakened bones that are more prone to fractures.  

If you are a patient who needs to use PPIs, there may be ways you can mitigate the risk of bone fractures. 

Understanding Proton Pump Inhibitors

PPIs are a class of medications that reduce stomach acid production by blocking (or inhibiting) the activity of proton pumps in the stomach lining. Commonly prescribed examples include omeprazole, esomeprazole, lansoprazole, and pantoprazole. There are even over-the-counter options that do not require a prescription, and therefore, are more difficult to monitor long-term use.  

While these drugs have proven effective in managing acid-related disorders, recent studies have suggested a potential downside to their long-term use.  

The Link Between Proton Pump Inhibitors and Osteoporosis

Several studies have investigated the relationship between proton pump inhibitors and osteoporosis, and although the findings are not definitive, a growing body of evidence suggests a correlation between prolonged PPI use and an increased risk of bone fractures. 

It is not uncommon that someone will be prescribed one of these medications after an endoscopy or simply to treat the effects of GERD (heartburn) and that medication will get refilled over and over without question. When these medications were first introduced, they were meant as temporary prescriptions. Now, it is common to have them re-prescribed for years.  

The Journal of Bone and Mineral Research in 2019 published that there is a modest but statistically significant association between proton pump inhibitors and osteoporosis fractures, particularly in the hip and spine. Another study in the American Journal of Gastroenterology in 2019 reported an increased risk of hip fractures in postmenopausal women who used PPIs for an extended period. 

The mechanism behind this link is not entirely understood, but researchers hypothesize that the reduced stomach acid secretion may interfere with the absorption of essential minerals like calcium. Calcium is a crucial building block for bone density, and any disruption in its absorption could decrease bone strength over time.  

Calcium is needed for heart and muscle health, as well as nervous system functioning. These functions are prioritized in the body and if there is not enough calcium to be dedicated to bone remodeling, the health of new bone tissue is compromised.  

Protecting Bone Health While Using PPIs

For patients who rely on PPIs to manage their gastrointestinal conditions, it’s essential to balance the benefits of these medications with potential risks to bone health. Here are some strategies to help lower the risk of osteoporosis and fractures while using PPIs: 

Regular Monitoring and Assessment

Regular check-ups with healthcare providers can help monitor bone density and assess any potential risks associated with PPI use. Individuals at higher risk, such as postmenopausal women and those over 65, may require more vigilant monitoring. 

Calcium and Vitamin D Supplementation

Since PPIs may interfere with calcium absorption, patients should consider calcium and vitamin D supplementation under the guidance of a healthcare professional. Adequate calcium intake is crucial for maintaining bone density, and vitamin D facilitates calcium absorption.  

In this situation, calcium should be taken with food and separate from the PPI, which works best when taken on an empty stomach.  

Weight-Bearing Exercise

Engaging in weight-bearing exercises, such as walking, jogging, or resistance training, can help strengthen bones and improve overall bone health. Regular physical activity is beneficial for maintaining bone density and reducing the risk of fractures. Ankle weights are a great addition to a walking routine to add more resistance to your bones and build strength over time.  

Dietary Changes

A diet rich in calcium and other bone-supporting nutrients is essential. Foods like dairy products, leafy green vegetables, and fortified foods can contribute to adequate calcium intake. If you are trying to avoid dairy, look for other fortified foods such as almond milk, oat milk, or coconut milk that also contain calcium.  

Limiting PPI Use to the Shortest Duration Necessary

Healthcare providers should reassess the necessity of long-term PPI use. If symptoms can be managed with lifestyle modifications, dietary changes, or alternative medications, the duration of PPI use should be limited to reduce the potential risks. 

While PPIs play a crucial role in managing acid-related disorders, it is important that we acknowledge there is a potential link between long-term use of proton pump inhibitors and osteoporosis. By adopting proactive measures such as regular monitoring, supplementation, exercise, and dietary changes, patients can find a balance between managing their gastrointestinal conditions and preserving bone health.  

If you are concerned about the duration of time you have been on a PPI, discuss this with your healthcare team to see if other options may be available to you.  

If you have osteoporosis and want to discuss treatment options, or are concerned about your osteoporosis risk, Summit Rheumatology is accepting new patients. Give us a call at (480) 494-2770 or send us a message to schedule your appointment.