XP: PPIs and Calcium Absorption -- Initial thoughts on findings
Ok.. so I've been asked this several times, and I decided to look into this.
As many know, a study was publicized (from 2006, mind you) that the elderly taking PPI's for long periods of time (>1 year) had over a 200% increased chance of hip fracture.
PPI's, or proton pump inhibitors, are drugs commonly prescribed post WLS to help a patient avoid ulcers down the road. Such drugs are Nexium, Axid, Prilosec, and Prevacid. This class does not include H2RAs (histamine-2 receptor antagonists), whi*****ludes the drugs Zantac and Tagament.
So what's the verdict? Am I scared? Yeah, sorta.
Oh. You want to know why? Ok.
We all have figured out that we need calcium citrate rather than some of the other forms of calcium (such as carbonate and dicalcium phosphate) due to the lack or low-levels of stomach acid. That's a whole 'nother post if you haven't figured this out. Moving on, here.
The problem with the PPI's is that they inhibit even more acid-production. Well, duh, right? That's the point. While we don't need that acid in the gut to absorb the calcium citrate (because of that nifty citrate part of the molecule), that PPI has a reaction elsewhere that we weren't thinking about.
The body is constantly resorbing tissue to rebuild it. We are the epitome of a well-designed recycling plant. Hell, ATP is recycled over 500 times a day in our systems. The body breaks down cells, reuses damaged pieces and parts, etc. The cells in the bones that do this function are called osteoclasts. Those little osteoclasts have, guess what, proton pumps in them. So the PPI's that we take for our stomach acid are also turning off the acid needed to resorb bone tissue in the osteoclasts.
But, isn't that a good thing?
The problem with this is when the body is building on already damaged bone tissue rather than replace that tissue with stronger tissue (i.e. non-porous bone mass). So, no, it's not necessarily a good thing. It can be, but not always.
Not only do we have malabsorption due to low gastric acid in our guts, but if we are on a long-term dose of PPI's, we could be telling our bones to not rebuild themselves.
Now, not all hope is lost. This was a preliminary study, and the study authors are begging the community at large to do more research. One area of research they would like to study more is in oisteoclast-selective PPI's, which could in essence, prevent bone loss. You bet I'm going to be doing more research to see if any of these are on the market at large, and so forth. Also, there's no proof that this will affect us as a community. The study group included those that were over 50 (with the mean age of 77), did not count the possibility of calcium supplementation, nor could it rule out other medications that this aged population is typically taking on a regular basis (including anti-seizure meds, anxiolytics, antidepressants, or antipsychotics -- keeping in mind that benzodiazepines and phenytonin have been associated with risk for osteoporosis and hip fractures). There are numerous factors that confound this study, so it's really too early to tell one way or another.
Right now, the current theme of advice is this:
"At this point, physicians should be aware of this potential association when considering PPI therapy and should use the lowest effective dose for patients with approprioate indications,: the authors conclude. "For elderly patients *****quire long-term and particularly high-dose PPI therapy, it may be prudent to reemphasize increased calcium intake, perfably from a dairy source, and coingestion of a meal when taking insoluble calcium supplements."
So yes, take your calcium, but take it with a meal for better absorption.
Also, I found conflicting answers to this question:
Do H2RA's (i.e. zantac) have the same incidence of hip fracture as PPI therapy? In one article, it stated that those on H2's had much lower statistical fractures than PPI's.. however, several other artlcles indicate that the rate was aproximately the same between low-dose PPI's and standard-dose H2 therapy.
Yes, I will be doing more research.. but felt this should get out there since it's on the mind of alot of people.
Remember -- I'm no doctor, nutritionist, dietician, or pharmacist. So take this info as I intend it -- for reference in order to make your own decisions.
As many know, a study was publicized (from 2006, mind you) that the elderly taking PPI's for long periods of time (>1 year) had over a 200% increased chance of hip fracture.
PPI's, or proton pump inhibitors, are drugs commonly prescribed post WLS to help a patient avoid ulcers down the road. Such drugs are Nexium, Axid, Prilosec, and Prevacid. This class does not include H2RAs (histamine-2 receptor antagonists), whi*****ludes the drugs Zantac and Tagament.
So what's the verdict? Am I scared? Yeah, sorta.
Oh. You want to know why? Ok.
We all have figured out that we need calcium citrate rather than some of the other forms of calcium (such as carbonate and dicalcium phosphate) due to the lack or low-levels of stomach acid. That's a whole 'nother post if you haven't figured this out. Moving on, here.
The problem with the PPI's is that they inhibit even more acid-production. Well, duh, right? That's the point. While we don't need that acid in the gut to absorb the calcium citrate (because of that nifty citrate part of the molecule), that PPI has a reaction elsewhere that we weren't thinking about.
The body is constantly resorbing tissue to rebuild it. We are the epitome of a well-designed recycling plant. Hell, ATP is recycled over 500 times a day in our systems. The body breaks down cells, reuses damaged pieces and parts, etc. The cells in the bones that do this function are called osteoclasts. Those little osteoclasts have, guess what, proton pumps in them. So the PPI's that we take for our stomach acid are also turning off the acid needed to resorb bone tissue in the osteoclasts.
But, isn't that a good thing?
The problem with this is when the body is building on already damaged bone tissue rather than replace that tissue with stronger tissue (i.e. non-porous bone mass). So, no, it's not necessarily a good thing. It can be, but not always.
Not only do we have malabsorption due to low gastric acid in our guts, but if we are on a long-term dose of PPI's, we could be telling our bones to not rebuild themselves.
Now, not all hope is lost. This was a preliminary study, and the study authors are begging the community at large to do more research. One area of research they would like to study more is in oisteoclast-selective PPI's, which could in essence, prevent bone loss. You bet I'm going to be doing more research to see if any of these are on the market at large, and so forth. Also, there's no proof that this will affect us as a community. The study group included those that were over 50 (with the mean age of 77), did not count the possibility of calcium supplementation, nor could it rule out other medications that this aged population is typically taking on a regular basis (including anti-seizure meds, anxiolytics, antidepressants, or antipsychotics -- keeping in mind that benzodiazepines and phenytonin have been associated with risk for osteoporosis and hip fractures). There are numerous factors that confound this study, so it's really too early to tell one way or another.
Right now, the current theme of advice is this:
"At this point, physicians should be aware of this potential association when considering PPI therapy and should use the lowest effective dose for patients with approprioate indications,: the authors conclude. "For elderly patients *****quire long-term and particularly high-dose PPI therapy, it may be prudent to reemphasize increased calcium intake, perfably from a dairy source, and coingestion of a meal when taking insoluble calcium supplements."
So yes, take your calcium, but take it with a meal for better absorption.
Also, I found conflicting answers to this question:
Do H2RA's (i.e. zantac) have the same incidence of hip fracture as PPI therapy? In one article, it stated that those on H2's had much lower statistical fractures than PPI's.. however, several other artlcles indicate that the rate was aproximately the same between low-dose PPI's and standard-dose H2 therapy.
Yes, I will be doing more research.. but felt this should get out there since it's on the mind of alot of people.
Remember -- I'm no doctor, nutritionist, dietician, or pharmacist. So take this info as I intend it -- for reference in order to make your own decisions.
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