Aasarød Kristin M, Mosti Mats P, Finstad Malin T, Stunes Astrid K, Fossmark Reidar, Syversen Unni
Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway.
Department of Gastroenterology and Hepatology, St. Olavs Hospital, Trondheim, Norway.
Bone Rep. 2021 May 20;14:101095. doi: 10.1016/j.bonr.2021.101095. eCollection 2021 Jun.
Patients with gastroesophageal reflux disease (GERD) are routinely treated with proton pump inhibitors (PPIs), despite many reports of increased fracture risk associated with PPI use. Notably, the skeletal properties in patients with GERD prior to PPI therapy have not been addressed. We hypothesized that PPI-naïve GERD patients have bone impairment, and that short-term treatment with PPI has minimal skeletal effects. To test this, 17 (12 men/5 women) GERD patients age 32-73 years, not previously exposed to PPI, and 17 age- and sex-matched controls were enrolled from September 2010 to December 2012. Bone mineral density (BMD) at lumbar spine, femoral neck, total hip, and trabecular bone score (TBS) at the lumbar spine, a marker of bone microarchitecture, were measured by dual X-ray absorptiometry. Markers of bone turnover and calcium homeostasis, and gastric hormones were analyzed. The same parameters were measured after three months of treatment with the PPI pantoprazole. The GERD patients displayed a significantly lower TBS at baseline than controls (1.31 ± 0.11 vs. 1.43 ± 0.07, p = 0.0006). Total hip and femoral neck BMD were lower in patients compared to controls, however, not significantly (p = 0.09 and 0.12, respectively). CTX was non-significantly higher in GERD patients at baseline (p = 0.11). After three months, changes in BMD, TBS and CTX did not differ between the groups. In conclusion, this is the first report demonstrating compromised bone quality and inferior BMD in PPI-naïve GERD patients. Treatment with pantoprazole did not influence bone parameters, indicating that short-term use with this PPI is safe for the skeleton.
尽管有许多报道称使用质子泵抑制剂（PPI）会增加骨折风险，但胃食管反流病（GERD）患者仍常规接受PPI治疗。值得注意的是，PPI治疗前GERD患者的骨骼特性尚未得到研究。我们假设未使用过PPI的GERD患者存在骨损害，且短期使用PPI对骨骼的影响最小。为了验证这一点，从2010年9月至2012年12月招募了17名（12名男性/5名女性）年龄在32 - 73岁、此前未接触过PPI的GERD患者以及17名年龄和性别匹配的对照者。通过双能X线吸收法测量腰椎、股骨颈、全髋部的骨密度（BMD）以及腰椎的骨小梁骨评分（TBS，骨微结构的一个指标）。分析骨转换和钙稳态的标志物以及胃激素。在使用PPI泮托拉唑治疗三个月后测量相同参数。GERD患者在基线时的TBS显著低于对照组（1.31±0.11 vs. 1.43±0.07，p = 0.0006）。患者的全髋部和股骨颈BMD低于对照组，但差异不显著（分别为p = 0.09和0.12）。GERD患者在基线时CTX略高但差异不显著（p = 0.11）。三个月后，两组之间BMD、TBS和CTX的变化没有差异。总之，这是第一份表明未使用过PPI的GERD患者骨质量受损和BMD较低的报告。泮托拉唑治疗不影响骨参数，表明短期使用该PPI对骨骼是安全的。
