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Published in: Osteoporosis International 6/2016

01-06-2016 | Original Article

Gastroesophageal reflux disease with proton pump inhibitor use is associated with an increased risk of osteoporosis: a nationwide population-based analysis

Authors: C.-H. Chen, C.-L. Lin, C.-H. Kao

Published in: Osteoporosis International | Issue 6/2016

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Abstract

Summary

Gastroesophageal reflux disease (GERD) with proton pump inhibitor (PPI) use is associated with an increased risk of osteoporosis. The risk of hip fracture is not increased in GERD patients with PPI use.

Introduction

The relationship between GERD with PPI treatment and the risk of osteoporosis is unclear. We aimed to determine the risk of developing osteoporosis in patients diagnosed with GERD.

Methods

Patients diagnosed with GERD and received PPI treatment between 2000 and 2010 were identified from the Longitudinal Health Insurance Database as the study cohort (n = 10,620), which was frequency matched with the comparison cohort (n = 20,738) sampled from the general population according to age, sex, index year, and comorbidities. Both cohorts were followed until the end of 2011. The risk of osteoporosis was evaluated in both groups by using Cox proportional hazards regression models.

Results

The GERD patients with PPI treatment had a greater incidence (31.4 vs 20.7 per 1000 person-year; crude hazard ratio [cHR] 1.51; 95 % confidence interval [CI] 1.40–1.63) and a higher risk (adjusted HR [aHR] 1.50; 95 % CI 1.39–1.62) of osteoporosis than that of the comparison cohort. However, the overall incidence of hip fracture was not different between the GERD with PPI use and the control cohorts (aHR 0.79; 95 % CI 0.53–1.18).

Conclusion

GERD with PPI use is associated with an increased risk of osteoporosis. The findings of our study do not support an increased risk of hip fracture in GERD patients treated with a PPI.
Literature
2.
go back to reference Dawson-Hughes B, Looker AC, Tosteson AN, Johansson H, Kanis JA, Melton LJ 3rd (2010) The potential impact of new National Osteoporosis Foundation guidance on treatment patterns. Osteoporos Int 21:41–52CrossRefPubMed Dawson-Hughes B, Looker AC, Tosteson AN, Johansson H, Kanis JA, Melton LJ 3rd (2010) The potential impact of new National Osteoporosis Foundation guidance on treatment patterns. Osteoporos Int 21:41–52CrossRefPubMed
3.
go back to reference Kinsella K, Wan H (2009) International Population Reports, p 95/09–1, An aging world: 2008. US Census Bureau, US Government Printing Office, Washington, DC Kinsella K, Wan H (2009) International Population Reports, p 95/09–1, An aging world: 2008. US Census Bureau, US Government Printing Office, Washington, DC
4.
go back to reference Xia WB, He SL, Xu L, Liu AM, Jiang Y, Li M, Wang O, Xing XP, Sun Y, Cummings SR (2012) Rapidly increasing rates of hip fracture in Beijing, China. J Bone Miner Res 27:125–129CrossRefPubMed Xia WB, He SL, Xu L, Liu AM, Jiang Y, Li M, Wang O, Xing XP, Sun Y, Cummings SR (2012) Rapidly increasing rates of hip fracture in Beijing, China. J Bone Miner Res 27:125–129CrossRefPubMed
5.
go back to reference Vakil N, van Zanten SV, Kahrlas P, Dent J, Jones R (2006) The Montrel definition and classification of gastroesophageal reflux disease: a global evidence-based consensus. Am J Gastroenterol 101:1900–1920CrossRefPubMed Vakil N, van Zanten SV, Kahrlas P, Dent J, Jones R (2006) The Montrel definition and classification of gastroesophageal reflux disease: a global evidence-based consensus. Am J Gastroenterol 101:1900–1920CrossRefPubMed
7.
go back to reference Bredenoord AJ, Pandolfino JE, Amout AJPM (2013) Gastro-oesophageal reflux disease. Lancet 381:1933–1942CrossRefPubMed Bredenoord AJ, Pandolfino JE, Amout AJPM (2013) Gastro-oesophageal reflux disease. Lancet 381:1933–1942CrossRefPubMed
8.
go back to reference Souza RF, Huo X, Mittal V, Schuler CM, Carmack SW, Zhang HY, Zhang X, Yu C, Hormi-Carver K, Genta RM, Spechler SJ (2009) Gastroesophageal reflux might cause esophagitis through a cytokine-mediated mechanisms rather than caustic acid injury. Gastroenterology 137:1776–1784CrossRefPubMed Souza RF, Huo X, Mittal V, Schuler CM, Carmack SW, Zhang HY, Zhang X, Yu C, Hormi-Carver K, Genta RM, Spechler SJ (2009) Gastroesophageal reflux might cause esophagitis through a cytokine-mediated mechanisms rather than caustic acid injury. Gastroenterology 137:1776–1784CrossRefPubMed
9.
go back to reference Oh TY, Lee JS, Ahn BO, Cho H, Kim WB, Kim YB, Surh YJ, Cho SW, Lee KM, Hahm KB (2001) Oxidative stress is more important than acid in the pathogenesis of reflux oesophagitis in rats. Gut 49:364–371CrossRefPubMedPubMedCentral Oh TY, Lee JS, Ahn BO, Cho H, Kim WB, Kim YB, Surh YJ, Cho SW, Lee KM, Hahm KB (2001) Oxidative stress is more important than acid in the pathogenesis of reflux oesophagitis in rats. Gut 49:364–371CrossRefPubMedPubMedCentral
10.
11.
go back to reference Lim SL, Goh WT, Lee JM, Ng TP, Ho KY, Community Medicine GI Study Group (2005) Changing prevalence of gastroesophageal reflux with changing time: longitudinal study in an Asian population. J Gastroenterol Hepatol 20:995–1001CrossRefPubMed Lim SL, Goh WT, Lee JM, Ng TP, Ho KY, Community Medicine GI Study Group (2005) Changing prevalence of gastroesophageal reflux with changing time: longitudinal study in an Asian population. J Gastroenterol Hepatol 20:995–1001CrossRefPubMed
12.
go back to reference Wong WM, Lai KC, Lam KF, Hui WM, Hu WH, Lam CL, Xia HH, Huang JQ, Chan CK, Lam SK, Wong BC (2003) Prevalence, clinical spectrum and health care utilization of gastro-oesophageal reflux disease in a Chinese population: a population-based study. Aliment Pharmacol Ther 18:595–604CrossRefPubMed Wong WM, Lai KC, Lam KF, Hui WM, Hu WH, Lam CL, Xia HH, Huang JQ, Chan CK, Lam SK, Wong BC (2003) Prevalence, clinical spectrum and health care utilization of gastro-oesophageal reflux disease in a Chinese population: a population-based study. Aliment Pharmacol Ther 18:595–604CrossRefPubMed
13.
go back to reference Chen M, Xiong I, Chen H, Xu A, He L, Hu P (2005) Prevalence, risk factors and impact of gastroesophageal reflux disease symptoms: a population-based study in South China. Scand J Gastroenterol 40:759–767CrossRefPubMed Chen M, Xiong I, Chen H, Xu A, He L, Hu P (2005) Prevalence, risk factors and impact of gastroesophageal reflux disease symptoms: a population-based study in South China. Scand J Gastroenterol 40:759–767CrossRefPubMed
14.
go back to reference Targownik LE, Lix LM, Metge CJ, Prior HJ, Leung S, Leslie WD (2008) Use of proton pump inhibitors and risk of osteoporosis-related fractures. CMAJ 179:319–326CrossRefPubMedPubMedCentral Targownik LE, Lix LM, Metge CJ, Prior HJ, Leung S, Leslie WD (2008) Use of proton pump inhibitors and risk of osteoporosis-related fractures. CMAJ 179:319–326CrossRefPubMedPubMedCentral
15.
go back to reference Vestergaard P, Rejnmark L, Mosekilde L (2006) Proton pump inhibitors, histamine H2 receptor antagonists, and other antacid medications and the risk of fracture. Calcif Tissue Int 79:76–83CrossRefPubMed Vestergaard P, Rejnmark L, Mosekilde L (2006) Proton pump inhibitors, histamine H2 receptor antagonists, and other antacid medications and the risk of fracture. Calcif Tissue Int 79:76–83CrossRefPubMed
16.
go back to reference Targownik LE, Lix LM, Leung S, Leslie WD (2010) Proton-pump inhibitor use is not associated with osteoporosis or accelerated bone mineral density loss. Gastroenterology 138:896–904CrossRefPubMed Targownik LE, Lix LM, Leung S, Leslie WD (2010) Proton-pump inhibitor use is not associated with osteoporosis or accelerated bone mineral density loss. Gastroenterology 138:896–904CrossRefPubMed
18.
go back to reference Siris ES, Adler R, Bilezikian J, Bolognese M, Dawson-Hughes B, Favus MJ, Harris ST, Jan de Beur SM, Khosla S, Lane NE, Lindsay R, Nana AD, Orwoll ES, Saag K, Silverman S, Watts NB (2014) The clinical diagnosis of osteoporosis: a position statement from the National Bone Health Alliance Working Group. Osteoporos Int 25:1439–1443CrossRefPubMedPubMedCentral Siris ES, Adler R, Bilezikian J, Bolognese M, Dawson-Hughes B, Favus MJ, Harris ST, Jan de Beur SM, Khosla S, Lane NE, Lindsay R, Nana AD, Orwoll ES, Saag K, Silverman S, Watts NB (2014) The clinical diagnosis of osteoporosis: a position statement from the National Bone Health Alliance Working Group. Osteoporos Int 25:1439–1443CrossRefPubMedPubMedCentral
19.
go back to reference Ford AC, Forman D, Reynolds PD, Cooper BT, Moayyedi P (2005) Ethnicity, gender, and socioeconomic status as risk factors for esophagitis and Barrett’s esophagus. Am J Epidemiol 162:454–460CrossRefPubMed Ford AC, Forman D, Reynolds PD, Cooper BT, Moayyedi P (2005) Ethnicity, gender, and socioeconomic status as risk factors for esophagitis and Barrett’s esophagus. Am J Epidemiol 162:454–460CrossRefPubMed
20.
go back to reference Menon S, Jayasena H, Nightingale P, Trudgill NJ (2011) Influence of age and sex on endoscopic findings of gastrooesophageal reflux disease: an endoscopy database study. Eur J Gastroenterol Hepatol 23:389–395CrossRefPubMed Menon S, Jayasena H, Nightingale P, Trudgill NJ (2011) Influence of age and sex on endoscopic findings of gastrooesophageal reflux disease: an endoscopy database study. Eur J Gastroenterol Hepatol 23:389–395CrossRefPubMed
21.
go back to reference Achem SR, DeVault KR (2014) Gastroesophageal reflux disease and the elderly. Gastroenterol Clin N Am 43:147–160CrossRef Achem SR, DeVault KR (2014) Gastroesophageal reflux disease and the elderly. Gastroenterol Clin N Am 43:147–160CrossRef
22.
go back to reference Sossalla S, Schotola H, Schmitto J, Toischer K, Sihns C, Schworer H, Hasenfuss G, Maier L, Schillinger W (2011) Effects of different proton pump inhibitors on cardiac contractility in isolated human failing myocardium. J Cardiovasc Surg 52:437–444 Sossalla S, Schotola H, Schmitto J, Toischer K, Sihns C, Schworer H, Hasenfuss G, Maier L, Schillinger W (2011) Effects of different proton pump inhibitors on cardiac contractility in isolated human failing myocardium. J Cardiovasc Surg 52:437–444
23.
go back to reference Khinchi P, Saha S, Saraf SA, Kaithwas G (2014) Combination therapy of gamma-aminobutyric acid derivative promotes proton pump inhibitor based healing of reflux esophagitis in animal model. Pharmacol Rep 66:165–168CrossRefPubMed Khinchi P, Saha S, Saraf SA, Kaithwas G (2014) Combination therapy of gamma-aminobutyric acid derivative promotes proton pump inhibitor based healing of reflux esophagitis in animal model. Pharmacol Rep 66:165–168CrossRefPubMed
24.
go back to reference Hall SD, Prokic EJ, McAllister CJ, Ronnqvist KC, Williams AC, Yamawaki N, Witton C, Woodhall GL, Stanford IM (2014) GABA-mediated changes in inter-hemispheric beta frequency activity in early-stage Parkinson’s disease. Neuroscience 281:68–76CrossRefPubMedCentral Hall SD, Prokic EJ, McAllister CJ, Ronnqvist KC, Williams AC, Yamawaki N, Witton C, Woodhall GL, Stanford IM (2014) GABA-mediated changes in inter-hemispheric beta frequency activity in early-stage Parkinson’s disease. Neuroscience 281:68–76CrossRefPubMedCentral
25.
go back to reference Sung HY, Park JW, Kim JS (2014) The frequency and severity of gastrointestinal symptoms in patients with early Parkinson’s disease. J Mov Disord 7:7–12CrossRefPubMedPubMedCentral Sung HY, Park JW, Kim JS (2014) The frequency and severity of gastrointestinal symptoms in patients with early Parkinson’s disease. J Mov Disord 7:7–12CrossRefPubMedPubMedCentral
26.
go back to reference Treiman DM (2001) GABAergic mechanisms in epilepsy. Epilepsia 42(suppl 3):8–12 Treiman DM (2001) GABAergic mechanisms in epilepsy. Epilepsia 42(suppl 3):8–12
27.
go back to reference Zhang J, Cui PL, Lv D, Yao SW, Xu YQ, Yang ZX (2011) Gastroesophageal reflux in cirrhotic patients without esophageal varices. World J Gastroenterol 17:1753–1758CrossRefPubMedPubMedCentral Zhang J, Cui PL, Lv D, Yao SW, Xu YQ, Yang ZX (2011) Gastroesophageal reflux in cirrhotic patients without esophageal varices. World J Gastroenterol 17:1753–1758CrossRefPubMedPubMedCentral
28.
go back to reference Giorgio M, Trinei M, Migliaccio E, Pelicci PG (2007) Hydrogen peroxide: a metabolic by-product or a common mediator of ageing signals? Nat Mol Cell Biol 8:722–728CrossRef Giorgio M, Trinei M, Migliaccio E, Pelicci PG (2007) Hydrogen peroxide: a metabolic by-product or a common mediator of ageing signals? Nat Mol Cell Biol 8:722–728CrossRef
29.
go back to reference Armas LAG, Recker RR (2012) Pathophysiology of osteoporosis. Endocrinol Metab Clin N Am 41:475–486CrossRef Armas LAG, Recker RR (2012) Pathophysiology of osteoporosis. Endocrinol Metab Clin N Am 41:475–486CrossRef
30.
go back to reference Ilic K, Obradovic N, Vujasinovic-Stupar N (2013) The relationship among hypertension, antihypertensive medications, and osteoporosis: a narrative review. Calcif Tissue Int 92:217–227CrossRefPubMed Ilic K, Obradovic N, Vujasinovic-Stupar N (2013) The relationship among hypertension, antihypertensive medications, and osteoporosis: a narrative review. Calcif Tissue Int 92:217–227CrossRefPubMed
31.
go back to reference Bagger YZ, Rasmussen HB, Alexandersen P, Werge T, Christiansen C, Tanko LB, PERF study group (2007) Links between cardiovascular disease and osteoporosis in postmenopausal women: serum lipids or atherosclerosis per se? Osteoporos Int 18:505–512CrossRefPubMedPubMedCentral Bagger YZ, Rasmussen HB, Alexandersen P, Werge T, Christiansen C, Tanko LB, PERF study group (2007) Links between cardiovascular disease and osteoporosis in postmenopausal women: serum lipids or atherosclerosis per se? Osteoporos Int 18:505–512CrossRefPubMedPubMedCentral
32.
go back to reference Pirih F, Lu J, Ye F, Bezouglaia O, Atti E, Ascenzi MG, Tetradis S, Demer L, Aghaloo T, Tintut Y (2012) Adverse effects of hyperlipidemia on bone regeneration and strength. JBMR 27:309–318CrossRef Pirih F, Lu J, Ye F, Bezouglaia O, Atti E, Ascenzi MG, Tetradis S, Demer L, Aghaloo T, Tintut Y (2012) Adverse effects of hyperlipidemia on bone regeneration and strength. JBMR 27:309–318CrossRef
33.
go back to reference Nakchbandi IA, Osteoporosis and fractures in liver disease (2014) Relevance, pathogenesis and therapeutic implications. World J Gastroenterol 20:9427–9438PubMedPubMedCentral Nakchbandi IA, Osteoporosis and fractures in liver disease (2014) Relevance, pathogenesis and therapeutic implications. World J Gastroenterol 20:9427–9438PubMedPubMedCentral
34.
go back to reference Weinstein RS (2012) Glucocorticoid-induced osteoporosis and osteonecrosis. Endocinol Metab Clin N Am 41:595–611CrossRef Weinstein RS (2012) Glucocorticoid-induced osteoporosis and osteonecrosis. Endocinol Metab Clin N Am 41:595–611CrossRef
35.
go back to reference Pack AM, Morrell MJ (2004) Epilepsy and bone health in adults. Epilepsy Behav 5(suppl 2):S24–S29 Pack AM, Morrell MJ (2004) Epilepsy and bone health in adults. Epilepsy Behav 5(suppl 2):S24–S29
36.
go back to reference Hill DD, Cauley JA, Sheu Y, Bunker CH, Patrick AL, Baker CE, Beckles GLA, Wheeler VW, Zmuda JM (2008) Correlates of bone mineral density in men of African ancestry: the Tobago Bone Health Study. Osteoporos Int 19:227–234CrossRefPubMed Hill DD, Cauley JA, Sheu Y, Bunker CH, Patrick AL, Baker CE, Beckles GLA, Wheeler VW, Zmuda JM (2008) Correlates of bone mineral density in men of African ancestry: the Tobago Bone Health Study. Osteoporos Int 19:227–234CrossRefPubMed
37.
go back to reference Fraser LA, Leslie WD, Targownik LE, Papaioannou A, Adachi JD, CaMos Research Group (2013) The effect of proton pump inhibitors on fracture risk: report from the Canadian Multicenter Study. Osteoporos Int 24:1161–1168CrossRefPubMed Fraser LA, Leslie WD, Targownik LE, Papaioannou A, Adachi JD, CaMos Research Group (2013) The effect of proton pump inhibitors on fracture risk: report from the Canadian Multicenter Study. Osteoporos Int 24:1161–1168CrossRefPubMed
38.
go back to reference Hinson AM, Wilkerson BM, Rothman-Fitts I, Rggs AT, Stack BC, Bodenner DL (2015) Hyperparathyroidism associated with long-term proton pump inhibitors independent of concurrent bisphosphonate therapy in elderly adults. J Am Geriatr Soc 63:2070–2073CrossRefPubMed Hinson AM, Wilkerson BM, Rothman-Fitts I, Rggs AT, Stack BC, Bodenner DL (2015) Hyperparathyroidism associated with long-term proton pump inhibitors independent of concurrent bisphosphonate therapy in elderly adults. J Am Geriatr Soc 63:2070–2073CrossRefPubMed
39.
go back to reference Soloman DH, Diem SJ, Ruppert K, Lian YJ, Liu CC, Wohlfart A, Greendale GA, Finkelstein JS (2015) Bone mineral density changes among women initiating proton pump inhibitors or H2 receptor antagonists: a Swan cohort study. JBMR 30:232–239CrossRef Soloman DH, Diem SJ, Ruppert K, Lian YJ, Liu CC, Wohlfart A, Greendale GA, Finkelstein JS (2015) Bone mineral density changes among women initiating proton pump inhibitors or H2 receptor antagonists: a Swan cohort study. JBMR 30:232–239CrossRef
40.
go back to reference Gray SL, LaCroix AZ, Larson J, Robbins J, Cauley JA, Manson JE, Chen Z (2010) Proton pump inhibitors use, hip fracture, and changes in bone mineral density in postmenopausal women. Arch Intern Med 170:765–771CrossRefPubMedPubMedCentral Gray SL, LaCroix AZ, Larson J, Robbins J, Cauley JA, Manson JE, Chen Z (2010) Proton pump inhibitors use, hip fracture, and changes in bone mineral density in postmenopausal women. Arch Intern Med 170:765–771CrossRefPubMedPubMedCentral
41.
go back to reference Kanis JA, Borgstrom F, De Laet C, Johansson H, Johnell O, Jonsson B, Oden A, Zethraeus N, Pfleger B, Khaltaev N (2005) Assessment of fracture risk. Osteoporos Int 16:581–589CrossRefPubMed Kanis JA, Borgstrom F, De Laet C, Johansson H, Johnell O, Jonsson B, Oden A, Zethraeus N, Pfleger B, Khaltaev N (2005) Assessment of fracture risk. Osteoporos Int 16:581–589CrossRefPubMed
42.
go back to reference Armour KJ, Armour KE, van’t Hof RJ, Reid DM, Wei XQ, Liew FY, Ralston SH (2001) Activation of the inducible nitric oxide synthase pathway contributes to inflammation-induced osteoporosis by suppressing bone formation and causing osteoblast apoptosis. Arthritis Rheum 44:2790–2796CrossRefPubMed Armour KJ, Armour KE, van’t Hof RJ, Reid DM, Wei XQ, Liew FY, Ralston SH (2001) Activation of the inducible nitric oxide synthase pathway contributes to inflammation-induced osteoporosis by suppressing bone formation and causing osteoblast apoptosis. Arthritis Rheum 44:2790–2796CrossRefPubMed
43.
go back to reference Sertorio JT (2013) Proton pump inhibitors and nitric oxide mechanisms in type 2 diabetes. Diabetologia 56:2763–2764CrossRefPubMed Sertorio JT (2013) Proton pump inhibitors and nitric oxide mechanisms in type 2 diabetes. Diabetologia 56:2763–2764CrossRefPubMed
44.
go back to reference Yang YX, Lewis JD, Epstein S, Metz DC (2006) Long-term proton pump inhibitor therapy and risk of hip fracture. JAMA 296:2947–2953CrossRefPubMed Yang YX, Lewis JD, Epstein S, Metz DC (2006) Long-term proton pump inhibitor therapy and risk of hip fracture. JAMA 296:2947–2953CrossRefPubMed
Metadata
Title
Gastroesophageal reflux disease with proton pump inhibitor use is associated with an increased risk of osteoporosis: a nationwide population-based analysis
Authors
C.-H. Chen
C.-L. Lin
C.-H. Kao
Publication date
01-06-2016
Publisher
Springer London
Published in
Osteoporosis International / Issue 6/2016
Print ISSN: 0937-941X
Electronic ISSN: 1433-2965
DOI
https://doi.org/10.1007/s00198-016-3510-1

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