• There is not a recognized interaction between bisphosphonates and PPIs.
• Use of acid suppressive medication can cause significant hypochlorhydria which could theoretically result in calcium malabsorption.
• PPIs appear to be associated with a limited increase in fracture risk, histamine H2 antagonists are associated with a small decrease in fracture risk and there is no evidence of a detrimental effect on bone mass. In all cases, the changes in risk estimates are small and the clinical significance is limited. Long term exposure and high doses significantly increases the risk of osteoporosis related fractures.
• A common side effect of bisphosphonates is gastro-intestinal (GI) disturbance, therefore doctors should use the lowest effective dose of PPI and the shortest possible duration for appropriate indications.
• For elderly patients who require long term and particularly high dose PPI therapy, it may be prudent to re-emphasise the need for increased calcium intake.