Disclosures None declared. Cochrane Renal Group, CRG110700124
Proton pump inhibitor omeprazole use is associated with low bone mineral density in maintenance haemodialysis patients
Article first published online: 15 JAN 2009
© 2009 The Authors. Journal compilation © 2009 Blackwell Publishing Ltd
International Journal of Clinical Practice
Volume 63, Issue 2, pages 261–268, February 2009
How to Cite
Kirkpantur, A., Altun, B., Arici, M. and Turgan, C. (2009), Proton pump inhibitor omeprazole use is associated with low bone mineral density in maintenance haemodialysis patients. International Journal of Clinical Practice, 63: 261–268. doi: 10.1111/j.1742-1241.2008.01883.x
- Issue published online: 15 JAN 2009
- Article first published online: 15 JAN 2009
- Paper received June 2008, accepted July 2008
Objective: Limited studies have shown that proton pump inhibitor (PPI) therapy may decrease bone density or insoluble calcium reabsorption through induction of hypochlorhydria. However, PPI therapy may also reduce bone resorption via inhibition of osteoclastic vacuolar proton pumps. The aim of this study was to determine whether the opposing effects of PPI therapy may cause clinically important alterations in bone mineral densitometry (BMD) parameters in maintenance haemodialysis patients.
Methods: Sixty-eight maintenance haemodialysis patients were enrolled in this study. Patients were classified into two groups involving users of PPI therapy (omeprazole 20 mg/day, group 1, n = 36 patients) and non-users of acid suppression drugs (group 2, n = 32 patients). Patients had radius, hip and spine BMD assessed by dual-energy X-ray absorptiometry.
Results: The mean duration of PPI therapy with omeprazole was 27 ± 5 months. The users of PPI therapy had lower values of bone mineral density and T-scores at the anatomical regions than non-users of acid suppression drugs. Serum calcium and phosphate levels, calcium-phosphate product and serum intact parathormone levels and the ratio of users of vitamin D therapy were similar among groups. A mutivariable adjusted odds ratio for lower bone density associated with more than 18 months of omeprazole, when all the potential confounders were considered, was 1.31 in the proximal radius, 0.982 in the femur neck, 0.939 in the trochanter and 1.192 in the lumbal spine.
Conclusion: The present data suggest that PPI therapy should be cautiously prescribed in maintenance haemodialysis patients, especially with lower BMD values.