Proton pump inhibitors therapy and risk of bone diseases: An update meta-analysis

Liu, Jian; Li, Xianqing; Fan, Lei; Yang, Jie; Wang, Jiecong; Sun, Jiaming; Wang, Zhenxing

doi:10.1016/j.lfs.2018.12.058

Cited by 68 publications

(52 citation statements)

References 48 publications

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“…In a recently published meta-analysis [ 313 ] which included 33 studies ( n = 2,714,502), subjects taking PPIs demonstrated a significantly increased overall fracture incidence (22.04% vs. 15.57% in controls) with pooling OR of 1.28 (95% CI 1.22–1.35); fracture risk raised with duration of PPI use (OR 1.29 in short users and 1.62 in long users), but no effect on BMD was found. Similar results were obtained in another meta-analysis [ 289 ]: PPI users, compared to non-users, had an increased risk of developing spine fracture (HR 1.49; 95% CI 1.31–1.68), hip fracture (HR 1.22; 95% CI 1.15–1.31), any-site fracture (HR 1.30; 95% CI 1.16–1.45) and OP (HR 1.23; 95% CI 1.06–1.42), but there was no correlation with BMD loss neither in the spine, nor in the hip. According to the latest meta-analysis (24 observational studies with 2,103,800 participants, 319,568 hip fracture patients), risk of hip fracture increased significantly in PPI users (RR 1.20, 95% CI 1.14–1.28), and the association was observed even in subjects taken low doses of PPI [ 314 ].…”

Section: Hpi-induced Upper Gut Diseases and Osteoporotic Fracturessupporting

confidence: 91%

“…A positive, albeit modest, association between PPIs and OP was reported in animal [ 262 , 263 , 264 ] and numerous of human studies. Many studies and meta-analyses suggested that acid inhibitors, especially the PPIs, moderately increase risk of fractures, particularly in older adults (who are already at higher fracture risk); the risk increases with longer durations of PPI use, often only in the presence of at least one other RF for OP such as older age, female gender and a higher comorbidity score [ 265 , 266 , 267 , 268 , 269 , 270 , 271 , 272 , 273 , 274 , 275 , 276 , 277 , 278 , 279 , 280 , 281 , 282 , 283 , 284 , 285 , 286 , 287 , 288 , 289 , 290 ]. Moreover, use of PPIs may also increase risk of falls [ 291 , 292 , 293 ].…”

Section: Hpi-induced Upper Gut Diseases and Osteoporotic Fracturesmentioning

confidence: 99%

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Helicobacter pylori Related Diseases and Osteoporotic Fractures (Narrative Review)

Fisher

Smith

2020

JCM

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Osteoporosis (OP) and osteoporotic fractures (OFs) are common multifactorial and heterogenic disorders of increasing incidence. Helicobacter pylori (H.p.) colonizes the stomach approximately in half of the world’s population, causes gastroduodenal diseases and is prevalent in numerous extra-digestive diseases known to be associated with OP/OF. The studies regarding relationship between H.p. infection (HPI) and OP/OFs are inconsistent. The current review summarizes the relevant literature on the potential role of HPI in OP, falls and OFs and highlights the reasons for controversies in the publications. In the first section, after a brief overview of HPI biological features, we analyze the studies evaluating the association of HPI and bone status. The second part includes data on the prevalence of OP/OFs in HPI-induced gastroduodenal diseases (peptic ulcer, chronic/atrophic gastritis and cancer) and the effects of acid-suppressive drugs. In the next section, we discuss the possible contribution of HPI-associated extra-digestive diseases and medications to OP/OF, focusing on conditions affecting both bone homeostasis and predisposing to falls. In the last section, we describe clinical implications of accumulated data on HPI as a co-factor of OP/OF and present a feasible five-step algorithm for OP/OF risk assessment and management in regard to HPI, emphasizing the importance of an integrative (but differentiated) holistic approach. Increased awareness about the consequences of HPI linked to OP/OF can aid early detection and management. Further research on the HPI–OP/OF relationship is needed to close current knowledge gaps and improve clinical management of both OP/OF and HPI-related disorders.

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Section: Hpi-induced Upper Gut Diseases and Osteoporotic Fracturessupporting

confidence: 91%

Section: Hpi-induced Upper Gut Diseases and Osteoporotic Fracturesmentioning

confidence: 99%

Helicobacter pylori Related Diseases and Osteoporotic Fractures (Narrative Review)

Fisher

Smith

2020

JCM

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“…Disturbance of bone metabolism and vitamin D alteration in patients with GEP-NET and MEN1 are mainly related to the coexistence of HPT, but the association of gastrinoma and ZES seem to worsen HPT. Furthermore, the long-term treatment of gastrinoma with proton pump inhibitors may moderately increase the risk of any-site, hip, or spine fracture [121,122]. Long-term follow-up studies, including large populations, are needed to increase the knowledge of bone metabolism and recoverability in MEN1.…”

Section: Gep-net Associated To Men1 and Bone Healthmentioning

confidence: 99%

Bone Metabolism and Vitamin D Implication in Gastroenteropancreatic Neuroendocrine Tumors

Altieri¹,

Dato

Modica

et al. 2020

Nutrients

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Patients affected by gastroenteropancreatic–neuroendocrine tumors (GEP–NETs) have an increased risk of developing osteopenia and osteoporosis, as several factors impact on bone metabolism in these patients. In fact, besides the direct effect of bone metastasis, bone health can be affected by hormone hypersecretion (including serotonin, cortisol, and parathyroid hormone-related protein), specific microRNAs, nutritional status (which in turn could be affected by medical and surgical treatments), and vitamin D deficiency. In patients with multiple endocrine neoplasia type 1 (MEN1), a hereditary syndrome associated with NET occurrence, bone damage may carry other consequences. Osteoporosis may negatively impact on the quality of life of these patients and can increment the cost of medical care since these patients usually live with their disease for a long time. However, recommendations suggesting screening to assess bone health in GEP–NET patients are missing. The aim of this review is to critically analyze evidence on the mechanisms that could have a potential impact on bone health in patients affected by GEP–NET, focusing on vitamin D and its role in GEP–NET, as well as on factors associated with MEN1 that could have an impact on bone homeostasis.

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“…There is robust evidence supporting the increased risk for nosocomial pneumonia (PPI and H2B), clostridium difficile infection (PPI>H2B association), hypomagnesemia (PPI>H2B association), and bone health complications (PPI). [52][53][54][55] MANAGEMENT OF PATIENTS WITH PERI-OPERATIVE ANEMIA Anemia is another common complication in the postoperative setting, occurring in up to 80% to 90% of individuals undergoing major surgery. 56 Anemia is defined by the WHO as a hemoglobin less than 13 g/dL in males and less than 12 g/dL in females.…”

Section: Assessment and Management Of Postoperative Ileusmentioning

confidence: 99%

Management of Common Postoperative Complications

Stephenson

Mohabbat

Raslau

et al. 2020

Mayo Clinic Proceedings

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Proton pump inhibitors therapy and risk of bone diseases: An update meta-analysis

Cited by 68 publications

References 48 publications

Helicobacter pylori Related Diseases and Osteoporotic Fractures (Narrative Review)

Helicobacter pylori Related Diseases and Osteoporotic Fractures (Narrative Review)

Bone Metabolism and Vitamin D Implication in Gastroenteropancreatic Neuroendocrine Tumors

Management of Common Postoperative Complications

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