质子泵抑制剂与骨质疏松

Proton pump inhibitors and osteoporosis

质子泵抑制剂(proton pump inhibitors,PPIs)是临床用于治疗与酸相关性疾病的基础药物,很多患者需要长期服用。长期服用该类药物可能会增加骨质疏松性骨折的风险,其机制尚不十分清楚,可能与PPI抑制胃酸分泌,导致肠道钙离子吸收障碍,反馈性引起甲状旁腺激素(parathyroid hormone,PTH)、1,25双羟基维生素D_3[1,25-dihydroxyvitamin D_3,1,25(OH)_2D_3]等分泌增加,促进溶骨,增加骨吸收等有关。有骨折高危风险的患者使用质子泵抑制剂应有适应证,用药时尽量控制在最小有效使用剂量范围内,以期在达到治疗目的基础上降低骨质疏松症与骨质疏松性骨折的发生率。

Proton pump inhibitors （PPIs） have been a cornerstone in treatment of acid-related diseases. Many patients need take this kind of medication continuously. Studies have reported that the association between the acid-suppressive medications and the risk of osteoporosis-related fractures. Although the pathophysiology mechanisms is still pre- mature, one of the possible reasons is that the proton pump inhibitors restrain the gastric acid secretion, which can lead to calcium malabsorption. Consequently, parathyroid hormone （PTH） and 1, 25-dihydroxyvitamin D3 （1,25 （OH）2 D3 ） secretion increase by feedback control system regulation, then bone loss and absorption increase. Clinicians must be gradually vigilant ensuring that the proton pump inhibitors are used sparingly and only when absolutely indicated, to make sure decreasing the the occurrence of osteoporosis-related fractures.