Dina Salem, Elhamy El-Kholy, Hala Abdel Malak, Abdelhadi M Sheb and Mahmoud Abdalla
Background: Osteoporosis is the most common age-related skeletal chronic disorder. The use of acid-suppressive drugs (especially: proton pump inhibitors; PPIs and H2 receptor blockers; H2RAs) is widespread in osteoporotic patients. to counteract inflammation and ulceration of esophagus and stomach caused by prolonged use of anti-resorptive medications bisphosphonates especially fracture risk While, others have not observed any fracture risk with the use of PPIs . The data on the effects of H2RAs are conflicting too. These drugs can reduce gastric acid secretion by up to 98% , irreversibly deactivating the proton pump (H+/K+ ATPase) of the gastric parietal cells. H2RAs (cimetidine, ranitidine, famotidine) competitively inhibit H2 receptors, have similar effects to PPIs, although they are less potent, blocking only 70% of gastric acid production . It has been suggested a possible association between gastric acid suppressants and increased hip, spine, and any-site fractures risk has been found in previous studies. Several mechanisms of this association have been proposed in theory, such as the possibility that PPIs decrease calcium-absorption, leading to bone mineral density (BMD) loss or they decrease magnesium absorption, which is important to bone health, other studies suggest that these agents can cause hyperparathyroidism by acid suppression and lead to decrease in BMD.
