DDW Researcher Blog: PPIs not linked to bone loss in women

In this researcher blog from Digestive Disease Week, Karen Hansen, MD, MS, associate professor of medicine at the University of Wisconsin School of Medicine and Public Health, reviews her latest data on proton pump inhibitors. She cares for patients within the rheumatology and osteoporosis clinics at UW Health and the VA Hospital. Her research has focused on osteoporosis and more specifically, factors that influence intestinal calcium absorption in postmenopausal women.

Gastroesophageal reflux disease, or heartburn, is extremely common, with up to one in four American adults experiencing symptoms at least once a month. The mainstay of treatment is proton pump inhibitors, which reduce stomach acid and relieve heartburn. An estimated 21 million Americans take PPIs, such as Prilosec (omeprazole, Procter & Gamble), Dexilant (dexlansoprazole, Takeda) and Nexium (esomeprazole, AstraZeneca) to treat GERD.

In recent years, several observational studies have suggested a possible link between PPI therapy and risk of osteoporosis with bone fractures. However, these findings have not been consistent, and because these studies were observational in nature, they cannot prove that PPIs cause fractures or how this might occur.

Our team performed a randomized, placebo-controlled study in postmenopausal women to test the potential effect of PPIs on bone loss, calcium absorption and mineral levels. We focused on older women, because these individuals have the highest risk of osteoporosis, and could be harmed most by taking PPIs.

We shared our study results with colleagues attending Digestive Disease Week 2017, the world’s largest gathering of physicians and researchers in the fields of gastroenterology, hepatology, endoscopy and gastrointestinal surgery.

We randomly assigned one of two PPIs (dexlansoprazole or esomeprazole) or placebo to 115 healthy postmenopausal women for 6 months. At the end of the study, we found that there were no PPI-related significant changes in bone mineral density; intestinal calcium absorption; or calcium, phosphorus or vitamin D levels. Bone turnover markers increased in women taking PPIs compared to women taking placebo, yet the levels remained within normal ranges.

PPIs relieve heartburn and in some cases, can also reduce the risk of potentially life-threatening conditions related to chronic heartburn, like esophageal cancer.

While we cannot completely exclude the possibility that PPIs could cause fractures after very long exposure, our results indicate that people can take PPI therapy for up to 6 months without any significant effect on bone metabolism or bone density. Therefore, our study suggests that physicians should be reassured in prescribing PPIs for 6 months.

Reference: Hansen K. Abstract 240. Presented at: Digestive Disease Week; May 6-9, 2017; Chicago.

Disclosures: This study was funded by Takeda.