Chronic PPI Use Did Not Lower BMD in Children in Pilot Study


NATIONAL HARBOR, MD. — Bone mineralization was not significantly altered among 17 children receiving chronic proton pump inhibitor therapy, including 12 who were also using inhaled steroids.

Proton pump inhibitors (PPIs) are commonly prescribed for acid suppression in children with gastroesophageal reflux, sometimes for long periods.

A significantly increased risk of bone fracture has been reported in adult patients receiving long-term PPI therapy (JAMA 2006;296:2947-53), and chronic acid suppression has also been shown to impair calcium absorption, thereby promoting bone resorption (Am. J. Med. 2005;118:778-81).

However, this pilot study is believed to be the first to look at bone mineralization or fractures in children on PPIs, Dr. Stephanie Willot said in a poster presentation at the annual meeting of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition.

The 17 patients (12 boys) had a mean age of 7.8 years (range 0.8-16.7 years). All had severe gastroesophageal reflux secondary to esophageal atresia and had received PPI therapy at a mean dosage of 2.0 mg/kg daily (1.0-3.2 mg/kg) for a mean of 2.6 years (0.6-11.3 years). Twelve of the children were also receiving chronic inhaled steroid therapy for pulmonary disease.

Lumbar spine areal bone mineral density (BMD) was assessed by using dual x-ray absorptiometry and was compared with normative data. Volumetric BMD, a parameter that more accurately assesses BMD in patients with short stature, was also calculated in order to account for differences in bone size, said Dr. Willot of the division of pediatric gastroenterology at Sainte-Justine Hospital, University of Montreal, who conducted the study with colleagues from the division of pediatric endocrinology.

No patient had a history of traumatic fracture. Five patients (29%) had a statural growth delay of less than −2 standard deviations for age. Among the 14 children older than 2 years, 5 (35%) had a body mass index less than the 10th percentile.

No patient had a significantly low BMD, defined in the study as a z score less than −2 standard deviations for age. Although six patients (35%) had a z score BMD of less than −1 standard deviation for age, they all had normal volumetric BMD (ranging from −0.8 to 0.6 standard deviation), as did the other seven children who were older than 4 years of age, Dr. Willot and her associates reported.

In a follow-up interview, Dr. Willot said that, given the small sample size of the study and its cross-sectional nature, its implications are limited to the finding that BMD is not low in children on chronic PPI therapy. “We cannot conclude about the association between PPI and fracture risk. In the future, we would like to follow our cohort to assess BMD in a longitudinal way to establish if z score could decrease during the course of PPI treatment.”

Dr. Willot stated that she had no personal financial disclosures.

Next Article: