Yang Yu-Xiao
Division of Gastroenterology, Center for Clinical Epidemiology and Biostatistics, and Department of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA.
Curr Drug Saf. 2008 Sep;3(3):204-9. doi: 10.2174/157488608785699414.
Osteoporotic fractures, particularly hip fractures, can have a devastating impact on the well-being of the elderly population. Recently, two population-based observational studies reported a highly important association between the use of potent acid suppressive therapy and an increased risk of hip fractures. The mechanisms underlying such an association are not clear. However, a careful review of the existing evidence seems to suggest that the main physiologic consequences of proton pump inhibitor therapy may each have a theoretical influence on bone metabolism. Specifically, inhibition of the osteoclastic proton pumps may reduce bone resorption, while profound acid suppression could potentially hamper intestinal calcium absorption, and secondary hypergastrinemia may enhance bone resorption through the induction of parathyroid gland hyperplasia. However, the existing data are clearly too limited for us to draw any definitive conclusions, and more studies are urgently needed to delineate the physiologic relevance of these theoretical mechanistic links, individually and collectively.
骨质疏松性骨折，尤其是髋部骨折，会对老年人群的健康产生毁灭性影响。最近，两项基于人群的观察性研究报告了强效抑酸治疗的使用与髋部骨折风险增加之间存在高度重要的关联。这种关联背后的机制尚不清楚。然而，对现有证据的仔细审查似乎表明，质子泵抑制剂治疗的主要生理后果可能各自对骨代谢产生理论影响。具体而言，抑制破骨细胞质子泵可能会减少骨吸收，而深度抑酸可能会阻碍肠道钙吸收，继发性高胃泌素血症可能通过诱导甲状旁腺增生来增强骨吸收。然而，现有数据显然过于有限，我们无法得出任何明确的结论，迫切需要更多研究来分别和综合地阐明这些理论机制联系的生理相关性。
