The association between proton pump inhibitors and hyperparathyroidism: a potential mechanism for increased fracture—results of a large observational cohort study
Authors' conclusion
The results are consistent with the hypothesis of PPIs reducing calcium absorption, leading to a rise in PTH which could mediate increased fracture risk. No relationship of PPI use with hyperparathyroidism was observed in non-users of calcium supplements, possibly owing to lower dietary calcium intake. These results highlight the importance of monitoring PPI use, especially in older adults at risk of fracture.
Study context
- Population
- Older Irish adults from the TUDA study; excluded estimated glomerular filtration rate (eGFR) < 30 ml/min and serum calcium > 2.5 mmol/l
- Participants
- 4,139 adults
- Exposure
- PPI users vs non-users
- PPI usersn = 1,563
- Outcome
- Hyperparathyroidism (parathyroid hormone (PTH) > 65 pg/ml)
Methodological detailsobservational, multivariate regression
- Observational
- Multivariate regression
Main finding
As reported in the abstract
Hyperparathyroidism prevalence
P < 0.001
Observational data: associations, not effects.
Further findings
| Outcome | OR (CI) | P value | |
|---|---|---|---|
| Hyperparathyroidism in calcium supplement users | 1.56 (1.08–2.23) | P = 0.018 | |
| 0.512Odds ratio (log scale) |
Age
P < 0.001
- Hyperparathyroidism in calcium supplement users: adjusted for age, sex, BMI, serum vitamin D, eGFR, timed-up-and-go, dairy intake, medications, comorbidities
Hyperparathyroidism in non-users of calcium supplements
- No relationship of PPI use with hyperparathyroidism
PPI use by calcium supplement status
- PPI use in calcium supplement users
- 41.4%
- PPI use in non-calcium supplement users
- 35.4%
Original publication
The association between proton pump inhibitors and hyperparathyroidism: a potential mechanism for increased fracture—results of a large observational cohort study. Osteoporos Int. Published 2 August 2023. doi:10.
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