Proton Pump Inhibitor Use and Bone Health in Patients With Rheumatic Diseases: A Cross-Sectional Study

Andriko Palmowski; Gabriela Schmajuk; Jinoos Yazdany; Patricia Katz; Jing Li; Rachael Stovall; Emma Kersey; Sabrina M. Nielsen; Robin Christensen; Henning Bliddal; Zhivana Boyadzhieva; Udo Schneider; Tobias Alexander; Burkhard Muche; Sandra Hermann; Edgar Wiebe; Frank Buttgereit

doi:10.1016/j.mayocp.2023.12.008

Proton Pump Inhibitor Use and Bone Health in Patients With Rheumatic Diseases: A Cross-Sectional Study

Andriko Palmowski^*
, Gabriela Schmajuk
, Jinoos Yazdany
, Patricia Katz
, Jing Li
, Rachael Stovall
, Emma Kersey
, Sabrina M. Nielsen
, Robin Christensen
, Henning Bliddal
, Zhivana Boyadzhieva
, Udo Schneider
, Tobias Alexander
, Burkhard Muche
, Sandra Hermann
, Edgar Wiebe
, Frank Buttgereit

^*Corresponding author af dette arbejde

Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › peer review

Abstract

Objective
To assess the effect of proton pump inhibitor (PPI) use on bone mineral density (BMD) and bone microarchitecture as measured by the trabecular bone score (TBS) in patients with inflammatory rheumatic and musculoskeletal diseases (iRMDs).

Methods
Cross-sectional data from a prospective single-center cohort (2015 to 2022) of patients with iRMDs were used to evaluate 3 co-primary outcomes: BMD of the left femoral neck and the lumbar spine (as T-scores) and the TBS. Inverse probability weighting adjusted for numerous confounders including age, sex, body mass index, current and cumulative glucocorticoid (GC) dose, C-reactive protein levels, disability, and others. Analyses were based on general linear models, following a prespecified statistical analysis plan.

Results
The study included 1495 patients (75% women; mean age, 62.6±13.1 years; 49% and 63% with regular PPI and GC use, respectively). The PPI users had lower BMD at both spine (adjusted contrast −0.25; 95% CI, −0.47 to −0.04; P =.02) and femoral neck (−0.17 [−0.35 to 0.01]; P =.07). Differences between PPI users and nonusers were statistically significant only in patients concurrently using GCs at more than 7.5 mg/d prednisone equivalent. The TBS was similar in PPI users and nonusers (adjusted contrast, 0.00 [−0.04 to 0.04]; P =.97).

Conclusion
Our results suggest that PPIs lead to a loss of BMD rather than an impairment of bone microarchitecture in patients with iRMDs. The negative association between PPI use and BMD appears to be dependent on concurrent GC use. Clinicians should carefully review the indication for PPI use in patients with iRMDs, especially in those receiving higher dose GCs

Originalsprog	Engelsk
Tidsskrift	Mayo Clinic Proceedings
Vol/bind	99
Udgave nummer	7
Sider (fra-til)	1046-1057
Antal sider	12
ISSN	0025-6196
DOI	https://doi.org/10.1016/j.mayocp.2023.12.008
Status	Udgivet - 2024
Udgivet eksternt	Ja

Bibliografisk note

Funding Information:
Grant Support: A.P. was supported by a research grant from the Deutsche Autoimmun-Stiftung (German Autoimmune Foundation). Rh-GIOP is or was supported by a joint funding of AbbVie, Amgen, Almirall, Biogen, BMS, Chugai, Galapagos, Generic Assays, GSK, Hexal, Horizon Therapeutics, Lilly, Medac, Mundipharma, Novartis, Pfizer, Roche, and Sanofi-Genzyme. The Parker Institute is supported by a core grant from the Oak Foundation (OCAY-18-774-OFIL). J.Y. is supported by NIH/NIAMS K24-AR-074534 and P30-AR-070155. R.S. is supported by NIH/NCATS through UCSF-CTSI grant TL1 TR001871.

Publisher Copyright:
© 2023 Mayo Foundation for Medical Education and Research

Finansiering

Grant Support: A.P. was supported by a research grant from the Deutsche Autoimmun-Stiftung (German Autoimmune Foundation). Rh-GIOP is or was supported by a joint funding of AbbVie, Amgen, Almirall, Biogen, BMS, Chugai, Galapagos, Generic Assays, GSK, Hexal, Horizon Therapeutics, Lilly, Medac, Mundipharma, Novartis, Pfizer, Roche, and Sanofi-Genzyme. The Parker Institute is supported by a core grant from the Oak Foundation (OCAY-18-774-OFIL). J.Y. is supported by NIH/NIAMS K24-AR-074534 and P30-AR-070155. R.S. is supported by NIH/NCATS through UCSF-CTSI grant TL1 TR001871.

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Citationsformater

Palmowski, A., Schmajuk, G., Yazdany, J., Katz, P., Li, J., Stovall, R., Kersey, E., Nielsen, S. M., Christensen, R., Bliddal, H., Boyadzhieva, Z., Schneider, U., Alexander, T., Muche, B., Hermann, S., Wiebe, E., & Buttgereit, F. (2024). Proton Pump Inhibitor Use and Bone Health in Patients With Rheumatic Diseases: A Cross-Sectional Study. Mayo Clinic Proceedings, 99(7), 1046-1057. https://doi.org/10.1016/j.mayocp.2023.12.008

Palmowski, A, Schmajuk, G, Yazdany, J, Katz, P, Li, J, Stovall, R, Kersey, E, Nielsen, SM, Christensen, R, Bliddal, H, Boyadzhieva, Z, Schneider, U, Alexander, T, Muche, B, Hermann, S, Wiebe, E & Buttgereit, F 2024, 'Proton Pump Inhibitor Use and Bone Health in Patients With Rheumatic Diseases: A Cross-Sectional Study', Mayo Clinic Proceedings, bind 99, nr. 7, s. 1046-1057. https://doi.org/10.1016/j.mayocp.2023.12.008

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title = "Proton Pump Inhibitor Use and Bone Health in Patients With Rheumatic Diseases: A Cross-Sectional Study",

abstract = "Objective: To assess the effect of proton pump inhibitor (PPI) use on bone mineral density (BMD) and bone microarchitecture as measured by the trabecular bone score (TBS) in patients with inflammatory rheumatic and musculoskeletal diseases (iRMDs). Methods: Cross-sectional data from a prospective single-center cohort (2015 to 2022) of patients with iRMDs were used to evaluate 3 co-primary outcomes: BMD of the left femoral neck and the lumbar spine (as T-scores) and the TBS. Inverse probability weighting adjusted for numerous confounders including age, sex, body mass index, current and cumulative glucocorticoid (GC) dose, C-reactive protein levels, disability, and others. Analyses were based on general linear models, following a prespecified statistical analysis plan. Results: The study included 1495 patients (75\% women; mean age, 62.6±13.1 years; 49\% and 63\% with regular PPI and GC use, respectively). The PPI users had lower BMD at both spine (adjusted contrast −0.25; 95\% CI, −0.47 to −0.04; P=.02) and femoral neck (−0.17 [−0.35 to 0.01]; P=.07). Differences between PPI users and nonusers were statistically significant only in patients concurrently using GCs at more than 7.5 mg/d prednisone equivalent. The TBS was similar in PPI users and nonusers (adjusted contrast, 0.00 [−0.04 to 0.04]; P=.97). Conclusion: Our results suggest that PPIs lead to a loss of BMD rather than an impairment of bone microarchitecture in patients with iRMDs. The negative association between PPI use and BMD appears to be dependent on concurrent GC use. Clinicians should carefully review the indication for PPI use in patients with iRMDs, especially in those receiving higher dose GCs",

author = "Andriko Palmowski and Gabriela Schmajuk and Jinoos Yazdany and Patricia Katz and Jing Li and Rachael Stovall and Emma Kersey and Nielsen, \{Sabrina M.\} and Robin Christensen and Henning Bliddal and Zhivana Boyadzhieva and Udo Schneider and Tobias Alexander and Burkhard Muche and Sandra Hermann and Edgar Wiebe and Frank Buttgereit",

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year = "2024",

doi = "10.1016/j.mayocp.2023.12.008",

language = "English",

volume = "99",

pages = "1046--1057",

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TY - JOUR

T1 - Proton Pump Inhibitor Use and Bone Health in Patients With Rheumatic Diseases

T2 - A Cross-Sectional Study

AU - Palmowski, Andriko

AU - Schmajuk, Gabriela

AU - Yazdany, Jinoos

AU - Katz, Patricia

AU - Li, Jing

AU - Stovall, Rachael

AU - Kersey, Emma

AU - Nielsen, Sabrina M.

AU - Christensen, Robin

AU - Bliddal, Henning

AU - Boyadzhieva, Zhivana

AU - Schneider, Udo

AU - Alexander, Tobias

AU - Muche, Burkhard

AU - Hermann, Sandra

AU - Wiebe, Edgar

AU - Buttgereit, Frank

PY - 2024

Y1 - 2024

N2 - Objective: To assess the effect of proton pump inhibitor (PPI) use on bone mineral density (BMD) and bone microarchitecture as measured by the trabecular bone score (TBS) in patients with inflammatory rheumatic and musculoskeletal diseases (iRMDs). Methods: Cross-sectional data from a prospective single-center cohort (2015 to 2022) of patients with iRMDs were used to evaluate 3 co-primary outcomes: BMD of the left femoral neck and the lumbar spine (as T-scores) and the TBS. Inverse probability weighting adjusted for numerous confounders including age, sex, body mass index, current and cumulative glucocorticoid (GC) dose, C-reactive protein levels, disability, and others. Analyses were based on general linear models, following a prespecified statistical analysis plan. Results: The study included 1495 patients (75% women; mean age, 62.6±13.1 years; 49% and 63% with regular PPI and GC use, respectively). The PPI users had lower BMD at both spine (adjusted contrast −0.25; 95% CI, −0.47 to −0.04; P=.02) and femoral neck (−0.17 [−0.35 to 0.01]; P=.07). Differences between PPI users and nonusers were statistically significant only in patients concurrently using GCs at more than 7.5 mg/d prednisone equivalent. The TBS was similar in PPI users and nonusers (adjusted contrast, 0.00 [−0.04 to 0.04]; P=.97). Conclusion: Our results suggest that PPIs lead to a loss of BMD rather than an impairment of bone microarchitecture in patients with iRMDs. The negative association between PPI use and BMD appears to be dependent on concurrent GC use. Clinicians should carefully review the indication for PPI use in patients with iRMDs, especially in those receiving higher dose GCs

AB - Objective: To assess the effect of proton pump inhibitor (PPI) use on bone mineral density (BMD) and bone microarchitecture as measured by the trabecular bone score (TBS) in patients with inflammatory rheumatic and musculoskeletal diseases (iRMDs). Methods: Cross-sectional data from a prospective single-center cohort (2015 to 2022) of patients with iRMDs were used to evaluate 3 co-primary outcomes: BMD of the left femoral neck and the lumbar spine (as T-scores) and the TBS. Inverse probability weighting adjusted for numerous confounders including age, sex, body mass index, current and cumulative glucocorticoid (GC) dose, C-reactive protein levels, disability, and others. Analyses were based on general linear models, following a prespecified statistical analysis plan. Results: The study included 1495 patients (75% women; mean age, 62.6±13.1 years; 49% and 63% with regular PPI and GC use, respectively). The PPI users had lower BMD at both spine (adjusted contrast −0.25; 95% CI, −0.47 to −0.04; P=.02) and femoral neck (−0.17 [−0.35 to 0.01]; P=.07). Differences between PPI users and nonusers were statistically significant only in patients concurrently using GCs at more than 7.5 mg/d prednisone equivalent. The TBS was similar in PPI users and nonusers (adjusted contrast, 0.00 [−0.04 to 0.04]; P=.97). Conclusion: Our results suggest that PPIs lead to a loss of BMD rather than an impairment of bone microarchitecture in patients with iRMDs. The negative association between PPI use and BMD appears to be dependent on concurrent GC use. Clinicians should carefully review the indication for PPI use in patients with iRMDs, especially in those receiving higher dose GCs

U2 - 10.1016/j.mayocp.2023.12.008

DO - 10.1016/j.mayocp.2023.12.008

M3 - Journal article

C2 - 38752948

AN - SCOPUS:85194565621

SN - 0025-6196

VL - 99

SP - 1046

EP - 1057

JO - Mayo Clinic Proceedings

JF - Mayo Clinic Proceedings

IS - 7

ER -