Proton pump inhibitors (PPIs) is associated with a dose-dependent loss of protection against hip fracture with alendronate in elderly patients

Team@CMHF

• PPIs are widely used in elderly patients and are frequently co-administered in users of oral bisphosphonates
• Biologically, PPIs could affect the absorption of calcium, vitamin B12, and bisphosphonates and could affect the osteoclast proton pump, thus interacting with bisphosphonate antifracture efficacy.
• Moreover, PPIs themselves have been linked to osteoporotic fractures.
• PPI dose and patient age affected the degree of attenuation of the risk reduction. Unlike the effect of PPIs, concurrent use of histamine H2 receptor blockers had no significant effect on the treatment effect of alendronate.
• Dose-response relationship and the lack of impact of prior PPI use provide reasonable grounds for discouraging the use of PPIs to control upper gastrointestinal tract complaints in patients treated with oral bisphosphonates.”
• Although the mechanism by which PPIs decreased the effectiveness of alendronate is not known, patients taking alendronate represent a group for whom alternatives to PPIs should be sought.
• All medications have adverse effects. The issue is being certain that the benefits of any medication exceed the risks and that have been identified by all those opportunities where less is more.

More at http://www.medscape.com/viewarticle/737427?src=mpnews&spon=34