LOSEC 10 MG
ATC Code
A02BC01
Warning
Calcium (Ca) absorption in patients on PPI therapy
Long term, high dose PPI therapy was associated with a small increased risk of hip fracture, hypothesized to be related to a decrease in insoluble calcium absorption
and possibly inhibition of the osteoclast H+/K+ ATPase pump (resulting in decreased bone resorption).
What does this mean for PPI users?
If patients consume the majority of their recommended Ca intake from dietary sources (soluble Ca), then it is unlikely that PPI therapy places them at
increased risk of hip fracture. However, patients receiving most or all of the recommended Ca from supplements, intervention may be required, depending
on the calcium supplement formulation. The carbonate salt needs an acidic environment to dissolve and subsequently be absorbed.
Options to optimize Ca intake/absorption are: 1) take it with meals to maximize presence of gastric acid, 2) take it with acidic food/drink OR BEST OPTION: 3) switch to calcium citrate because it does not need an acidic environment for absorption. One study in achlorhydric patients showed significantly higher bioavailability with
citrate vs carbonate (45 % vs 4 % respectively).
The drawback though is that Ca citrate supplements often require more frequent dosing/number of pills per day to achieve the recommended daily Ca intake.
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