Department of Gastroenterology, Umraniye Training and Research Hospital, Adem Yavuz Cad. No: 1, Umraniye-Istanbul, Turkey.
Rheumatol Int. 2013 Sep;33(9):2255-60. doi: 10.1007/s00296-013-2709-0. Epub 2013 Mar 2.
Patients with gastroesophageal reflux disease (GERD) receive long-term therapy with proton pump inhibitor (PPI) agents. Several studies have recently been published suggesting that treatment with PPI may cause bone fractures, although the number of prospective studies in this regard is limited. The aim of this study is to prospectively investigate the effect of PPIs on bone density. Between March 2009 and January 2011, 114 GERD patients (18-56 years) and 110 healthy controls were included in the present study. Bone mineral densitometry (BMD) by using dual-energy X-ray absorptiometry was assessed at lumbar spine and femur neck. BMD measurements were performed on all subjects at the beginning of the study. The patients were divided according to three drugs by their treatment with esomeprazole, lansoprazole, or pantoprazole. The study group was followed for at least 6 months on PPI therapy, and then BMD measurements were repeated. The mean duration of treatment with PPIs was 8.5 ± 2.3 months. In patients receiving PPIs, the mean reduction in total vertebra T score following treatment compared to pre-treatment values was 00.23 ± 0.42 units (95 % CI 0.15-0.30) (p < 0.01), while the mean reduction in the femur T score was 0.10 ± 0.40 units (95 % CI 0.03-0.18) (p = 0.03). Reduction following treatment in L4 and total vertebra T scores of lansoprazole group was significantly higher than of pantoprazole group (p = 0.04). Reduction in femur T score of esomeprazole group was higher than of lansoprazole group and pantroprazole group, but it is not statistically significant. Treatment with a PPI results in a significant reduction in bone density. Close monitoring is beneficial for patients who are to receive long-term treatment with PPI.
胃食管反流病（GERD）患者接受质子泵抑制剂（PPI）的长期治疗。最近发表了几项研究表明，PPI 治疗可能导致骨折，尽管这方面的前瞻性研究数量有限。本研究旨在前瞻性研究 PPI 对骨密度的影响。2009 年 3 月至 2011 年 1 月，纳入了 114 例 GERD 患者（18-56 岁）和 110 例健康对照者。采用双能 X 线吸收法测定腰椎和股骨颈的骨矿物质密度（BMD）。所有研究对象在研究开始时均进行 BMD 测量。根据药物的不同，将患者分为埃索美拉唑、兰索拉唑或泮托拉唑三组。研究组接受 PPI 治疗至少 6 个月，然后重复 BMD 测量。PPI 治疗的平均时间为 8.5±2.3 个月。接受 PPI 治疗的患者，与治疗前相比，治疗后总椎体 T 评分平均降低 0.23±0.42 个单位（95%CI 0.15-0.30）（p<0.01），股骨 T 评分平均降低 0.10±0.40 个单位（95%CI 0.03-0.18）（p=0.03）。兰索拉唑组 L4 和总椎体 T 评分的降低显著高于泮托拉唑组（p=0.04）。埃索美拉唑组的股骨 T 评分降低高于兰索拉唑组和泮托拉唑组，但无统计学意义。PPI 治疗可导致骨密度显著降低。对于接受 PPI 长期治疗的患者，密切监测是有益的。
