Background/Purpose: Recent studies suggest that proton pump inhibitor (PPI) use is variably associated with risk of osteoporosis. The aim of this study was to investigate the relationship between PPI use and development of osteoporosis in Scleroderma (SSc) patients. This association however has not been well characterized in a large cohort of patients.

Methods: We reviewed the records of patients followed up in our centre over a period of 10 years. Those who have had at least one bone densitometry (DEXA) performed were included in the study. Demographic and basic clinical characteristics were recorded for all patients, including results of the DEXA scans and PPI treatment prior to DEXA (none, standard dose PPIs or high dose PPIs). In addition, data on potential confounding factors, such as smoking history, steroid or bisphosphonate treatment, were also collected. Ordinal logistic regression was used to assess the effects of these factors on the DEXA results.

Results: In this study 199 SSc patients were included. Of those 91% (n=182) were female, 31% (n=61) had diffuse disease. Mean age at first DEXA scan was 57 years (range 18 to 84 years). Mean disease duration at first DEXA was 12.7 years (interquartile range 5.8 to 18.5). Bone density was normal in 21% (n=41), 40% (n=80) had osteopenia and 39% (n=78) had osteoporosis. By univariable analysis there was no significant association between prior PPI treatment and DEXA scan results (p=0.205). Among those who had normal DEXA 22% have not had treatment with PPIs, 49% have had standard dose and 29% have had high doses of PPIs. Among those with osteopenia, 12.5% had not been treated with PPIs, while 47.5% and 40% had received standard or high doses of PPIs respectively. Among subjects with osteoporosis, 27% had not had PPI treatment, while 41% and 32% have had standard and higher than standard doses of PPIs. We found no association between gender, disease subset or antibody specificity and bone density. Body mass index (BMI) was negatively associated with development of osteoporosis (OR 0.89; 95% CI 0.84, 0.94; p<0.001), while age showed a strong positive association (OR 1.07; 95% CI 1.04, 1.1; p<0.001). Presence of calcinosis showed a mild, borderline significant association with development of osteoporosis (OR 1.67, 95% CI 0.91, 3.06; p=0.096). Interestingly, there was a strong association between calcinosis and PPI use; among patients who had not received PPIs, calcinosis was present in 12.5%, among those on standard dose PPIs, 20% had calcinosis and among those on high doses of PPIs, calcinosis was present in 39%, p=0.003. Multivariable analysis of the effect of PPIs on bone density was fitted. After adjusting for age, BMI, steroid and bisphosphonate treatment, there was no association between PPI treatment and development of osteopenia or osteoporosis.

Conclusion: Our data do not support an association between prior PPI treatment and development of osteoporosis. However, the association of calcinosis with prior PPI treatment and trend of association of calcinosis with osteoporosis is noteworthy and warrants further study in other cohorts. Our results suggest that addressing coexisting risk factors for osteoporosis is required for SSc patients on PPI.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/the-lack-of-association-of-osteoporosis-with-proton-pump-inhibitor-in-scleroderma-a-uk-single-centre-cohort-experience/