SEARCHCOHORTendocrinology, geriatrics

cohort·endocrinology, geriatrics, epidemiology, internal medicine, observational study·PMC10579148

The association between proton pump inhibitors and hyperparathyroidism: a potential mechanism for increased fracture—results of a large observational cohort study

Osteoporosis International · 11 authors, 4 centres

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TL;DR

Participants were drawn from the TUDA cross-sectional cohort of older Irish adults.

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Participants were drawn from the TUDA cross-sectional cohort of older Irish adults. Multivariate regression models were used to analyse the relationship. Among calcium supplement users, PPI use was significantly associated with hyperparathyroidism after adjusting for age, sex, BMI, serum vitamin D, eGFR, timed-up-and-go, dairy intake, medications, and comorbidities. These findings are consistent with the hypothesis that PPIs reduce calcium absorption, leading to a rise in PTH that could mediate increased fracture risk.

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cohort

SPECIALTY

endocrinology

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ORIGINAL PAPER

PMC10579148

The association between proton pump inhibitors and hyperparathyroidism: a potential mechanism for increased fracture—results of a large observational cohort study

Osteoporosis International

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ABSTRACT

Abstract Summary Proton pump inhibitors (PPIs) are associated with increased risk of osteoporotic fracture; however, the mechanism is unclear. PPI users taking calcium supplements were more likely to have hyperparathyroidism compared to non-users (OR 1.56, CI 1.08–2.23, p = 0.018). This highlights the importance of monitoring PPI use, especially in older adults. Purpose Proton pump inhibitors (PPIs) are associated with increased risk of osteoporotic fracture. Hyperparathyroidism may be implicated, but few studies have considered this relationship. This study evaluated the relationship between PPI use and hyperparathyroidism in older adults. Methods Participants were from the TUDA study, a large cross-sectional cohort of older Irish adults. Participants with an estimated glomerular filtration rate (eGFR) < 30 ml/min and serum calcium > 2.5 mmol/l were excluded to avoid hyperparathyroidism due to chronic renal disease and primary hyperparathyroidism. Hyperparathyroidism was defined as a parathyroid hormone (PTH) > 65 pg/ml. Multivariate regression models were used to analyse the relationship between PPI use and hyperparathyroidism. Results A total of 4139 participants met the inclusion criteria, of whom 37.8% ( n = 1563) were taking PPI medication. PPI use was identified in 41.4% of calcium supplement users and 35.4% of non-calcium supplement users. Overall, compared to non-users of PPIs, those taking PPIs were older (74.8 vs 72.9 years, p < 0.001) and had a higher prevalence of hyperparathyroidism (17.8 vs 11.0%, p < 0.001). In those taking calcium supplements (but not in non-users), PPI use was significantly associated with hyperparathyroidism (OR 1.56, CI 1.08–2.23, p = 0.018) after adjusting for age, sex, body mass index, serum vitamin D, eGFR, timed-up-and-go, dairy intake, medications, and comorbidities. Discussion The results are consistent with the hypothesis of PPIs reducing calcium absorption, leading to a rise in PTH which could mediate increased fracture risk. No relationship of PPI use with hyperparathyroidism was observed in non-users of calcium supplements, possibly owing to lower dietary calcium intake. These results highlight the importance of monitoring PPI use, especially in older adults at risk of fracture. Supplementary Information The online version contains supplementary material available at 10.1007/s00198-023-06867-8. Keywords: Calcium absorption, Hyperparathyroidism, Osteoporosis, Proton pump inhibitor

CITATION EXPORT

Donal Fitzpatrick, Rosaleen Lannon, Eamon Laird et al.. The association between proton pump inhibitors and hyperparathyroidism: a potential mechanism for increased fracture—results of a large observational cohort study. Osteoporosis International. (2023). https://doi.org/10.1007/s00198-023-06867-8

AUTHORS

11 · 4 CENTRES

Donal Fitzpatrick, Rosaleen Lannon, Eamon Laird, Mary Ward, Leane Hoey, Catherine F Hughes, J J Strain, Conal Cunningham, Helene McNulty, Anne M Molloy, Kevin McCarroll

1The Mercers Institute for Research On Ageing, St James’s Hospital, Dublin, Ireland
2School of Medicine, Trinity College, Dublin, Ireland
3Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland
4Nutrition Innovation Centre for Food and Health, University of Ulster, Coleraine, BT52 1SA Northern Ireland