Management of Bone and Joint Pain After PPI Therapy

Clinical Assessment and Management

The American Gastroenterological Association states there is insufficient evidence to advocate bone density studies or calcium supplementation specifically because of PPI use 1
Obtain a complete rheumatologic history and physical examination of all peripheral joints for tenderness, swelling, and range of motion, plus spine examination 2, 3, 4
Distinguish between arthralgias (joint pain without inflammation) versus true arthritis (pain with inflammation, erythema, or swelling) 2, 3
Order inflammatory markers (ESR, CRP) to assess for active inflammation 2, 3, 4
Consider autoimmune blood panel including ANA, RF, anti-CCP if symptoms persist 2, 4
Plain X-rays or imaging to exclude metastases and evaluate for joint damage or erosions 2, 4
Long-term PPI use is associated with an increased risk of hip fracture by 20% (RR=1.20) in meta-analyses 5
For symptomatic treatment of joint pain, initiate analgesia with acetaminophen and/or NSAIDs if no contraindications, and consider escalation of analgesia or referral to rheumatology as needed 2, 3, 4
Monitor patients with serial rheumatologic examinations and inflammatory markers every 4-6 weeks after treatment is instituted 2, 4