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

This study evaluated the relationship between PPI use and hyperparathyroidism in older adults.MethodsParticipants 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.ResultsA 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.DiscussionThe results are consistent with the hypothesis of PPIs reducing calcium absorption, leading to a rise in PTH which could mediate increased fracture risk. No r...
Source: Osteoporosis International - Category: Orthopaedics Source Type: research