An experimental study in mice has revealed that proton pump inhibitors (PPIs) delay fracture healing.1 Histing et al. investigated healing of an induced femur fracture in 21 mice treated with pantoprazole (100 mg per kg body weight, given as an intraperitoneal injection each day), and in 21 control mice given saline injections.
Five weeks after fracture, mice receiving PPI treatment had significantly less bony tissue within the callus, and more fibrous tissue and cartilage. The femurs in this group were biomechanically inferior compared to controls.
Analysis of bone formation markers showed that bone morphogenetic proteins 2 and 4, and cysteine-rich protein were all expressed at a lower level in PPI-treated animals. RANKL expression was also reduced, suggesting osteoclast inhibition. The authors conclude that the delayed healing was due to the effect of pantoprazole on bone remodeling and bone formation.
Editor's comment: This study shows that a proton pump inhibitor might have negative effects on fracture repair. While no human data are available, patients on proton pump inhibitors exhibiting delayed fracture healing might benefit from a temporary switch in therapy.
References
- Histing T, Stenger D, Scheuer C, Metzger W, Garcia P, Holstein JH et al. Pantoprazole, a proton pump inhibitor, delays fracture healing in mice. Calcif Tissue Int 2012;90:507–514. [DOI] [PubMed] [Google Scholar]
