长期使用质子泵抑制剂与骨密度和质量降低之间的性别特异性关联。
Sex-specific Association of Chronic Proton Pump Inhibitor Use With Reduced Bone Density and Quality.
作者信息
Bioletto Fabio, Pusterla Alessia, Fraire Federica, Sauro Lorenzo, Presti Michela, Arvat Emanuela, Ghigo Ezio, Procopio Massimo, Barale Marco
机构信息
Division of Endocrinology, Diabetes and Metabolism, Department of Medical Sciences, University of Turin, Turin, 10126, Italy.
Division of Oncological Endocrinology, Department of Medical Sciences, University of Turin, Turin, 10126, Italy.
出版信息
J Clin Endocrinol Metab. 2025 May 19;110(6):e2071-e2079. doi: 10.1210/clinem/dgae598.
CONTEXT
Chronic use of proton pump inhibitors (PPIs) has been associated with an increase in bone fragility. However, evidence on the effect of chronic PPI use on bone density is conflicting, and data on bone microarchitectural quality are scarce.
OBJECTIVE
The primary aim of this study was to evaluate whether trabecular bone microarchitecture, assessed by trabecular bone score (TBS), is altered in chronic PPI users. The association between PPI use and bone density was also evaluated as a secondary endpoint.
METHODS
We extracted individual patient data from the 2005 to 2008 cycles of the population-based National Health and Nutrition Examination Survey (NHANES), in which lumbar spine dual-energy X-ray absorptiometry scans were acquired. TBS values were calculated from dual-energy X-ray absorptiometry images using a dedicated software. Multivariable linear regression analyses stratified by sex were performed to evaluate the association of chronic PPI use with TBS and bone mineral density (BMD), adjusting for relevant confounders.
RESULTS
A total of 7478 subjects were included (3961 men, 3517 women). After adjustment for relevant confounders, chronic PPI use was associated with a worse bone health profile in men, with lower TBS (-0.039; 95% CI, -0.058 to -0.020; P < .001), lumbar spine T-score (-0.27; 95% CI, -0.51 to -0.04; P = .023), total hip T-score (-0.21; 95% CI, -0.41 to -0.01; P = .041), and femoral neck T-score (-0.22; 95% CI, -0.44 to -0.00; P = .047). Notably, the association between chronic PPI use and degraded TBS remained statistically significant even after further adjustment for BMD at lumbar spine and femoral neck (-0.026; 95% CI, -0.039 to -0.012; P = .001). In contrast, no significant association was observed between chronic PPI use and either TBS or BMD in women.
CONCLUSION
Chronic PPI use is associated with degraded trabecular bone quality in men, even after adjustment for BMD. No association was observed in women.
背景
长期使用质子泵抑制剂（PPI）与骨脆性增加有关。然而，关于长期使用PPI对骨密度影响的证据存在矛盾，且关于骨微结构质量的数据较少。
目的
本研究的主要目的是评估通过小梁骨评分（TBS）评估的小梁骨微结构在长期使用PPI的患者中是否发生改变。PPI使用与骨密度之间的关联也作为次要终点进行评估。
方法
我们从基于人群的国家健康与营养检查调查（NHANES）2005年至2008年周期中提取了个体患者数据，该调查获取了腰椎双能X线吸收法扫描结果。使用专用软件从双能X线吸收法图像计算TBS值。进行按性别分层的多变量线性回归分析，以评估长期使用PPI与TBS和骨矿物质密度（BMD）之间的关联，并对相关混杂因素进行调整。
结果
共纳入7478名受试者（3961名男性，3517名女性）。在对相关混杂因素进行调整后，长期使用PPI与男性较差的骨骼健康状况相关，TBS较低（-0.039；95%置信区间，-0.058至-0.020；P<.001），腰椎T值（-0.27；95%置信区间，-0.51至-0.04；P=.023），全髋T值（-0.21；95%置信区间，-0.41至-0.01；P=.041），以及股骨颈T值（-0.22；95%置信区间，-0.44至-0.00；P=.047）。值得注意的是，即使在进一步调整腰椎和股骨颈的BMD后，长期使用PPI与TBS降低之间的关联仍具有统计学意义（-0.026；95%置信区间，-0.039至-0.012；P=.001）。相比之下，在女性中未观察到长期使用PPI与TBS或BMD之间存在显著关联。
结论
即使在调整BMD后，长期使用PPI仍与男性小梁骨质量下降有关。在女性中未观察到关联。
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