Association Between PPI Use and Hyperparathyroidism Among Older Adults Taking Calcium Supplements

The use of proton pump inhibitors (PPIs) was associated with hyperparathyroidism among older adults taking calcium supplements, according to study results published in Osteoporosis International.

Investigators assessed the relationship between the use of PPIs and hyperparathyroidism among older adults.

Data were taken from the cross-sectional Trinity-Ulster-Department of Agriculture study (ClinicalTrials.gov Identifier: NCT02664584), conducted in Ireland.

Included patients were aged at least 60 years at the time of study recruitment. Patients with an estimated glomerular filtration rate (eGFR) of less than 30 mL/min and serum calcium greater than 2.5 mmol/L were excluded from the analysis.

Hyperparathyroidism was defined as a parathyroid hormone level greater than 65 pg/mL. Patients taking PPIs at the time of study recruitment were considered PPI users.   

A total of 4139 patients were included in the analysis, of whom 1621 (39.2%) were taking calcium supplements; of these, 41.4% were using PPIs, compared with 35.4% of patients not taking calcium supplements.

Patients using PPIs were generally older than non-users (mean age, 74.8 vs 72.9 years; P <.001) and were significantly more likely to have hyperparathyroidism (17.8% vs. 11.0%; P <.001).

Among patients taking calcium supplements, PPI use was associated with a 56% greater risk for hyperparathyroidism (odds ratio, 1.56; 95% CI, 1.08-2.23; P =.018), following adjustments for age, sex, body mass index, serum vitamin D level, eGFR, timed-up-and-go, dairy intake, medications, and comorbidities. This association did not remain significant among patients not taking calcium supplements after final adjusted analysis.

This study was limited by its cross-sectional design and lack of data on specific measurements of calcium intake and serum gastrin results. Additionally, the investigators did not assess the relationship between hyperparathyroidism and bone mineral density or fracture risk.

The study authors concluded, “Findings illustrate the importance of monitoring PPI use, especially in older adults at higher risk of osteoporotic fracture. Deprescribing of these medications when no longer indicated should be encouraged.”