From the Research
For osteoporosis patients requiring a proton pump inhibitor (PPI), lansoprazole is generally considered the best option, as it has been associated with a reduced risk of osteoporosis compared to other PPIs 1. The recommended dose is typically 30mg once daily, taken in the morning before breakfast. When prescribing for osteoporosis patients, the lowest effective dose should be used for the shortest duration necessary to manage symptoms. For long-term therapy, consider periodic attempts at discontinuation or dose reduction every 6-12 months. Additionally, ensure patients are taking adequate calcium (1000-1200mg daily) and vitamin D (800-1000 IU daily) supplements, but separate calcium intake from PPI administration by at least 2 hours to maximize absorption. Regular bone density monitoring is advisable for osteoporosis patients on long-term PPI therapy, with DEXA scans recommended every 1-2 years to assess for any accelerated bone loss.
Some key points to consider when prescribing PPIs to osteoporosis patients include:
- The potential for PPIs to increase fracture risk through reduced calcium absorption and altered bone remodeling 2, 3, 4
- The importance of using the lowest effective dose and shortest duration necessary to manage symptoms 2, 4
- The need for regular bone density monitoring and consideration of calcium and vitamin D supplementation 2, 4
- The potential differences in risk between different PPIs, with lansoprazole appearing to have a reduced risk of osteoporosis compared to other PPIs 1
It is also important to note that the evidence on the association between PPI use and osteoporosis risk is not entirely consistent, and further research is needed to fully understand the relationship between these two conditions 3, 4. However, based on the available evidence, lansoprazole appears to be a reasonable choice for osteoporosis patients requiring a PPI, and its use should be guided by careful consideration of the potential benefits and risks 1.