Impact of proton pump inhibitors on the musculoskeletal system: a narrative review of pathophysiological mechanisms and clinical implications

Proton pump inhibitors (PPIs) have been considered to have a relatively good safety profile. However, their generalized use and prolonged intake by the general population have led to the identification of some potential long-term adverse effects. Accordingly, the use of PPIs can affect the musculoskeletal system through the inhibition of the osteoclastic and granulocyte activity and by their interference with the absorption of calcium, magnesium, and vitamin B12. There are a significant number of studies reporting that these drugs could increase the risk of fractures in adults. There is growing evidence suggesting that PPIs could be a risk factor for osteoarthritis, and fracture nonunion, and may interfere with the osseointegration process in hip and knee arthroplasty. PPIs should, therefore, be prescribed with caution in patients with musculoskeletal conditions.