Study Suggests Long-Term, High Dose PPIs Should Be Avoided if Possible Interview with:
Andrew M Hinson, MD
UAMS Postdoctoral Research Fellow
Thyroid/Parathyroid Diseases & Surgery and
Donald L. Bodenner, MD, PhD
Department of Otolaryngology-Head and Neck Surgery
Department of Geriatrics
University of Arkansas for Medical Sciences, Little Rock, Arkansas.

Medical Research: What is the background for this study?

Response: Proton pump inhibitors (PPIs)​ are widely prescribed, highly effective and generally safe for the treatment of acid-related gastrointestinal disorders. However, there are risks that may be elevated for some older people when PPIs are used in high doses over long periods of time. There is also evidence that fracture risk may even be higher in older patients who are being treated with concurrent oral bisphosphonate medications, which are used to prevent fractures in patients with osteoporosis. While the mechanism remains unknown, PPIs may increase fracture risk by decreasing gastrointestinal absorption (e.g., calcium, vitamin B12, and/or bisphosphonates) or by inhibiting a major mechanism by which bisphosphonates work.

To learn more about this process, we studied patients 60 years or older with normal renal function and vitamin D levels to see how PPIs (with and without concurrent bisphosphonate administration) impacted measurements in parathyroid hormone (PTH) and calcium.

Medical Research: What are the main findings?

Response: We found that chronic PPI exposure in elderly adults is associated with mild secondary hyperparathyroidism regardless of concurrent oral blood pressure administration. Secondary hyperparathyroidism refers to the excessive secretion of PTH by the parathyroid glands in response to low blood calcium levels. This is often associated with renal failure; however, all of our patients had normal renal function.

Medical Research: What should clinicians and patients take away from your report?

Response: Long-term exposure and high-dose PPIs should be avoided whenever possible, and individuals’ indications for PPI use should be regularly reviewed to avoid potentially serious adverse effects that could otherwise be prevented.

Medical Research: What recommendations do you have for future research as a result of this study?

Response: Prospective randomized controlled trials are needed to determine whether these biochemical measures are of any clinical utility in regard to PPI-induced bone fragility or can be attributed to cofounding comorbidities more common in individuals chronically exposed to PPIs.


J Am Geriatr Soc. 2015 Oct;63(10):2070-3. doi: 10.1111/jgs.13661. Epub 2015 Sep 29.

Hyperparathyroidism Associated with Long-Term Proton Pump Inhibitors Independent of Concurrent Bisphosphonate Therapy in Elderly Adults.

Hinson AM1,2, Wilkerson BM2, Rothman-Fitts I2, Riggs AT2, Stack BC Jr1, Bodenner DL2.

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Andrew M Hinson, MD and Donald L. Bodenner, MD, PhD (2015). Study Suggests Long-Term, High Dose PPIs Should Be Avoided if Possible