Nephrology Unit, Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey.
Int J Clin Pract. 2009 Feb;63(2):261-8. doi: 10.1111/j.1742-1241.2008.01883.x.
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.
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.
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.
The present data suggest that PPI therapy should be cautiously prescribed in maintenance haemodialysis patients, especially with lower BMD values.
有限的研究表明，质子泵抑制剂（PPI）治疗可能通过诱导低胃酸来降低骨密度或不溶性钙重吸收。然而，PPI 治疗也可能通过抑制破骨细胞液泡质子泵来减少骨吸收。本研究旨在确定 PPI 治疗的相反作用是否会导致维持性血液透析患者骨矿物质密度（BMD）参数发生临床重要变化。
本研究纳入 68 例维持性血液透析患者。患者分为两组，包括使用 PPI 治疗的患者（奥美拉唑 20mg/天，组 1，n=36 例）和未使用酸抑制药物的患者（组 2，n=32 例）。通过双能 X 射线吸收法评估患者的桡骨、髋部和脊柱 BMD。
奥美拉唑 PPI 治疗的平均时间为 27±5 个月。与未使用酸抑制药物的患者相比，使用 PPI 治疗的患者在解剖部位的骨矿物质密度和 T 评分较低。血清钙和磷酸盐水平、钙磷乘积和血清全段甲状旁腺素水平以及维生素 D 治疗的使用者比例在各组之间相似。当考虑所有潜在混杂因素时，与使用奥美拉唑超过 18 个月相关的较低骨密度的多变量调整比值比在桡骨近端为 1.31，在股骨颈为 0.982，在转子间为 0.939，在腰椎为 1.192。
目前的数据表明，质子泵抑制剂（PPI）治疗应谨慎用于维持性血液透析患者，特别是骨密度值较低的患者。
