TIBBIYOT TA’LIMI VA INNOVATSIYALARI · Nov 9, 2026
Effects of proton pump inhibitors on the development of osteoporosis: pathogenetic mechanisms, risk factors, and clinical significance
By Лутфуллаев О
Proton pump inhibitors (ИПП) are widely used for acid-related gastrointestinal diseases. The question of the possible effect of long-term antisecretory therapy on bone tissue remains clinically relevant. The aim of this review is to summarize data on the association of ИПП use with bone mineral density, osteoporosis, and the risk of low-energy fractures, and to consider probable pathogenetic mechanisms and practical approaches to risk assessment. Changes in calcium salt solubility and absorption in hypochlorhydria, hypomagnesemia, possible effects on bone remodeling, and the role of concomitant factors are discussed. Observational studies and meta-analyses identify associations between ИПП use and fractures, but heterogeneity of results and residual confounding limit causal interpretation. Clinical guidelines do not recommend universal densitometry or prophylactic supplementation for all patients in the absence of additional risk factors. Appropriate prescribing of ИПП, use of the lowest effective dose, and individualized assessment of osteoporosis risk allow a rational balance between benefits and potential harms. EN Proton pump inhibitors (PPIs) are widely used to manage acid-related gastrointestinal disorders. Their potential long-term effects on bone mineral density, osteoporosis, and fragility fractures remain clinically relevant. This narrative review synthesizes the evidence regarding associations between PPI use and fractures, as well as proposed underlying mechanisms, including altered calcium salt solubility and absorption under conditions of acid suppression, hypomagnesemia, and possible changes in bone remodeling. Observational studies and meta-analyses report associations between PPI exposure and fractures; however, heterogeneity among the findings and residual confounding limit causal interpretation. Current clinical guidance does not recommend routine bone mineral density testing or prophylactic calcium and vitamin D supplementation solely on the basis of PPI use in patients without additional skeletal risk factors. Periodic reassessment of treatment indications, use of the lowest effective dose, and individualized fracturerisk assessment remain central to appropriate clinical practice. UZ Proton pump inhibitors (PPI) are widely used to treat acid-related gastrointestinal diseases. The potential effects of their long-term use on bone mineral density, osteoporosis, and the risk of low-energy fractures are a clinically relevant issue. The aim of this review is to summarize data on the association of PPI use with bone mineral density, osteoporosis, and the risk of low-energy fractures, and to analyze potential pathogenetic mechanisms and practical approaches to risk assessment. This literature review examined changes in calcium salt solubility and absorption under conditions of suppressed acid secretion, hypomagnesemia, bone remodeling, and additional risk factors. Although observational studies have identified an association between PPI use and fractures, these findings do not fully establish a causal relationship because of heterogeneity of results and residual confounding factors. Routine bone mineral density testing and prophylactic calcium and vitamin D supplementation are not considered mandatory for all patients without additional risk factors. Reassessment of treatment indications, selection of the lowest effective dose, and individualized assessment of osteoporosis risk are important.