All might not be lost, one hopes!!
A survey from 2015 Darrell Hulisz, RPh, PharmD
Marissa Wagner 2015
“A recent study is casting some doubt on whether patients on long-term proton pump inhibitors (PPI) require additional supplementation, such as calcium, vitamin D, vitamin B12, and iron. Data from two prospective trials, one of five years, the other of 12 years of continuous PPI use in over 800 patient showed no clinically relevant changes in vitamin D, vitamin B12 , folate and homocysteine levels over time.
PPIs inhibit the secretion of hydrochloric acid which mediates small intestinal absorption of calcium. Additionally, PPIs may lead to reduced bone resorption of calcium since osteoclasts possess proton pumps that may be affected by PPI therapy. To date, data linking PPI use to increased bone fracture are from retrospective observational studies. The data from these studies have been inconsistent. However, data from the Women's Health Initiative has led to the recommendation that older patients on long-term or high-dose PPI therapy should consider increased dietary or supplementary calcium and vitamin D intake to minimize the risk of fracture. If calcium supplementation is indicated, calcium citrate should be used since it can be absorbed without an acidic environment.”