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      Do Proton Pump Inhibitors Decrease Calcium Absorption?

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          Abstract

          Proton pump inhibitors (PPIs) increase osteoporotic fracture risk presumably via hypochlorhydria and consequent reduced fractional calcium absorption (FCA). Existing studies provide conflicting information regarding the direct effects of PPIs on FCA. We evaluated the effect of PPI therapy on FCA. We recruited women at least 5 years past menopause who were not taking acid suppressants. Participants underwent three 24-hour inpatient FCA studies using the dual stable isotope method. Two FCA studies were performed 1 month apart to establish baseline calcium absorption. The third study occurred after taking omeprazole (40 mg/day) for 30 days. Each participant consumed the same foods during all FCA studies; study meals replicated subjects' dietary habits based on 7-day diet diaries. Twenty-one postmenopausal women ages 58 ± 7 years (mean ± SD) completed all study visits. Seventeen women were white, and 2 each were black and Hispanic. FCA (mean ± SD) was 20% ± 10% at visit 1, 18% ± 10% at visit 2, and 23% ± 10% following 30 ± 3 days of daily omeprazole ( p = .07, ANOVA). Multiple linear regression revealed that age, gastric pH, serum omeprazole levels, adherence to omeprazole, and 25-hydroxyvitamin D levels were unrelated to changes in FCA between study visits 2 and 3. The 1,25-dihydroxyvitamin D 3 level at visit 2 was the only variable ( p = .049) associated with the change in FCA between visits 2 and 3. PPI-associated hypochlorhydria does not decrease FCA following 30 days of continuous use. Future studies should focus on identifying mechanisms by which PPIs increase the risk of osteoporotic fracture. © 2010 American Society for Bone and Mineral Research.

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          Most cited references37

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          R: A Language and Environment for Statistical Computing.

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            Homocysteine as a predictive factor for hip fracture in older persons.

            The increased prevalence of osteoporosis among people with homocystinuria suggests that a high serum homocysteine concentration may weaken bone by interfering with collagen cross-linking, thereby increasing the risk of osteoporotic fracture. We examined the association between the total homocysteine concentration and the risk of hip fracture in men and women enrolled in the Framingham Study. We studied 825 men and 1174 women, ranging in age from 59 to 91 years, from whom blood samples had been obtained between 1979 and 1982 to measure plasma total homocysteine. The participants in our study were followed from the time that the sample was obtained through June 1998 for incident hip fracture. Sex-specific, age-adjusted incidence rates of hip fracture were calculated for quartiles of total homocysteine concentrations. Cox proportional-hazards regression was used to calculate hazard ratios for quartiles of homocysteine values. The mean (+/-SD) plasma total homocysteine concentration was 13.4+/-9.1 micromol per liter in men and 12.1+/-5.3 micromol per liter in women. The median duration of follow-up was 12.3 years for men and 15.0 years for women. There were 41 hip fractures among men and 146 among women. The age-adjusted incidence rates per 1000 person-years for hip fracture, from the lowest to the highest quartile for total homocysteine, were 1.96 (95 percent confidence interval, 0.52 to 3.41), 3.24 (0.97 to 5.52), 4.43 (1.80 to 7.07), and 8.14 (4.20 to 12.08) for men and 9.42 (5.72 to 13.12), 7.01 (4.29 to 9.72), 9.58 (6.42 to 12.74), and 16.57 (11.84 to 21.30) for women. Men and women in the highest quartile had a greater risk of hip fracture than those in the lowest quartile--the risk was almost four times as high for men and 1.9 times as high for women. These findings suggest that the homocysteine concentration, which is easily modifiable by means of dietary intervention, is an important risk factor for hip fracture in older persons. Copyright 2004 Massachusetts Medical Society
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              Dietary Reference Intakes for Calcium, Phosphorus, Magnesium, Vitamin D, and Fluoride

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                Author and article information

                Journal
                J Bone Miner Res
                jbmr
                Journal of Bone and Mineral Research
                Wiley Subscription Services, Inc., A Wiley Company
                0884-0431
                1523-4681
                December 2010
                24 June 2010
                : 25
                : 12
                : 2786-2795
                Affiliations
                [1 ]simpleDepartments of Medicine, University of Wisconsin Madison, WI, USA
                [2 ]simpleDepartments of Biostatistics and Medical Informatics, and University of Wisconsin Madison, WI, USA
                [3 ]simpleCenter for Translational and Clinical Research Core; and the University of Wisconsin Madison, WI, USA
                [4 ]simpleNational Primate Research Center, University of Wisconsin Madison, WI, USA
                [5 ]simpleDepartments of Urology; the University of Wisconsin Madison, WI, USA
                [6 ]simpleWisconsin State Lab of Hygiene Madison, WI, USA
                Author notes
                Address correspondence to: Karen E Hansen, MD, MS, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Mailbox 3244, Clinical Science Center, 600 Highland Avenue, Madison, WI 53792, USA. E-mail: keh@ 123456medicine.wisc.edu
                Article
                10.1002/jbmr.166
                3179281
                20578215
                320cd692-9226-48d4-9a30-9ca304549465
                Copyright © 2010 American Society for Bone and Mineral Research

                Re-use of this article is permitted in accordance with the Creative Commons Deed, Attribution 2.5, which does not permit commercial exploitation.

                History
                : 23 March 2010
                : 04 June 2010
                : 11 June 2010
                Categories
                Original Article

                Human biology
                acid suppressant,fracture,osteoporosis,calcium absorption,bone
                Human biology
                acid suppressant, fracture, osteoporosis, calcium absorption, bone

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