PPIs and Osteoporosis

Posted by ChristyJ @christyj, Jun 24, 2021

Hi, I recently joined Mayo Clinic Connect and appreciate all the support that is shared here! I want to ask about PPIs and osteoporosis without writing a novel so I'll try to be brief.

2012 - Just before I turned 50, I was diagnosed with celiac disease (silent, no digestive symptoms) after extreme, unexplained weight loss. My endoscopy showed my small intestinal villi were cobblestoned. I lost 20% of my bone density, I had osteopenia in one measure and borderline osteoporosis in the other.

2015 - My bone density significantly improved on a gluten-free diet

2019 - Osteoporosis in both measurements, also discovered I was getting routinely glutened (again, no symptoms - I discovered this with a Nima gluten sensor) so I hoped removing this cross-contamination would allow me to reverse my bone loss again. I'm due for another DEXA scan shortly.

2021 - Had an endoscopy to check my villi which are fully recovered - hurray! However, I was diagnosed with duodenditis and esophagitis ( although I had no digestive symptoms).

My gastroenterologist prescribed omeprazole but that gave me abdominal pain so I stopped after two days. Then she recommended OTC Pepcid AC - which I took for 20 days but I started choking and throat clearing. Now she wants me to take lansoprazole for 90 days. I understand that PPIs interfere with calcium absorption and I don't want to lose more bone density but also want to heal my digestive system. I know bone fractures are associated with long-term PPI use but I already have osteoporosis so it seems like even short-term use is iffy. Has anyone here taken PPIs who had osteoporosis already? Did your bone density drop further? Also, do you know of any good references I could read about this?

Thanks for any information.

Interested in more discussions like this? Go to the Digestive Health Support Group.

John, Volunteer Mentor | @johnbishop | Jun 24, 2021

Hello @christyj, Welcome to Connect. I have osteopenia and degenerative arthritis but have no experience with Proton pump inhibitors (PPIs). I did find some references that may help you learn a little more until members with experience can share what they have learned or experienced.

2018 - Proton Pump Inhibitors: Review of Emerging Concerns:
-- https://www.mayoclinicproceedings.org/article/S0025-6196(17)30841-8/pdf
2019 - Proton Pump Inhibitors and Fracture Risk: A Review of Current Evidence and Mechanisms Involved
-- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6540255/
2020 - Proton Pump Inhibitors and Osteoporosis - Is Collagen a Direct Target?:
-- https://www.frontiersin.org/articles/10.3389/fendo.2020.00473/full

Is your main concern with the risk of fractures?

ChristyJ | @christyj | Jun 24, 2021

Hi John, thanks for your welcome and for the articles! Yes, I'm mainly concerned about fracture risk - I know long-term PPI use increases fracture risk (it says so right on the drug warnings from the pharmacy!) but I'm wondering if someone who already has osteoporosis is at higher fracture risk even with short-term use. Or if there aren't fractures, does it substantially worsen osteoporosis, thereby increasing the risk of future fractures? I'm "only" 58, and hope my bones will last me for many years to come.

My lesser concern is that I won't be able to tolerate any PPIs due to side effects but that isn't something anyone here can predict for me, I guess I'll have to just try a few more. Thanks again!