Aleraij Sara, Alhowti Sultan, Ferwana Mazen, Abdulmajeed Imad
Department of Family Medicine and PHC, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia.
National and Gulf Center for Evidence Based Health Practices, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
Bone Rep. 2020 Nov 10;13:100732. doi: 10.1016/j.bonr.2020.100732. eCollection 2020 Dec.
Despite the fact that proton pump inhibitors (PPIs) are one of the most prescribed medications, several epidemiological studies have reported many adverse effects related to their long-term usage. Nevertheless, there were inconsistent findings in the literature with regard to PPI use and bone mineral density (BMD) change. The aim of this systematic review and meta-analysis is to evaluate the association between the use of PPIs and change in BMD. The PubMed/MEDLINE, EMBASE, Cochrane and CINAHL databases were searched up to March 2019. Ten studies fulfilled the eligibility criteria (4761 cases and 30,809 controls), from which the mean difference and mean annualized percent change in BMD were pooled using RevMan 5.3.5 The results showed no statistically significant association between PPI users and non-users in mean annualized percent change in BMD (0.06; 95% CI -0.07, 0.18) with moderate heterogeneity (I: 63%). There was a statistically significant reduction in the mean BMD difference among PPI users (-0.03; 95% CI -0.04, -0.01) with no substantial heterogeneity (I: 26%). This meta-analysis reported inconsistent results regarding the use of PPIs and BMD loss. Thus, the effect of PPIs on BMD needs to be elucidated by other studies, and healthcare providers should prescribe PPIs with caution considering their unfavorable consequences on bone health.
尽管质子泵抑制剂（PPIs）是处方量最多的药物之一，但多项流行病学研究报告了与长期使用它们相关的许多不良反应。然而，关于PPI使用与骨密度（BMD）变化，文献中的研究结果并不一致。本系统评价和荟萃分析的目的是评估PPI使用与BMD变化之间的关联。检索了截至2019年3月的PubMed/MEDLINE、EMBASE、Cochrane和CINAHL数据库。十项研究符合纳入标准（4761例病例和30809例对照），使用RevMan 5.3.5汇总了BMD的平均差异和平均年化百分比变化。结果显示，PPI使用者和非使用者在BMD平均年化百分比变化方面无统计学显著关联（0.06；95%CI -0.07，0.18），异质性中等（I²：63%）。PPI使用者的平均BMD差异有统计学显著降低（-0.03；95%CI -0.04，-0.01），无实质性异质性（I²：26%）。该荟萃分析报告了关于PPI使用与BMD丢失的不一致结果。因此，PPI对BMD的影响需要其他研究来阐明，医疗保健提供者在开PPI处方时应谨慎考虑其对骨骼健康的不利影响。
