Chronic Proton Pump Inhibitor Use in Physically Active Individuals: Implications for Micronutrient Status, Bone Health and Physical Performance
DOI:
https://doi.org/10.12775/JEHS.2026.90.70339Keywords
proton pump inhibitors, physical perfomance, micronutrients, iron deficiency, vitamin B12, magnesium, calcium, bone health, long- term use of PPIAbstract
Proton pump inhibitors (PPIs) are widely used in the treatment of acid-related gastrointestinal disorders. Although generally safe in short-term therapy, increasing evidence suggests that long-term use may adversely affect micronutrient status and bone metabolism, which may be particularly relevant for physically active individuals. This review summarizes current evidence on the effects of chronic PPI use on micronutrient status and bone health, as well as its potential indirect impact on physical performance. A narrative review of peer-reviewed literature published between 2006 and 2025 was conducted, including systematic reviews, meta-analyses, and observational studies. The synthesis focused on PPI pharmacodynamics, micronutrient homeostasis (iron, vitamin B12, calcium, magnesium), musculoskeletal outcomes, and physical performance. Long-term PPI therapy leads to sustained gastric acid suppression, potentially impairing the absorption of key micronutrients. Evidence indicates associations with iron deficiency, altered vitamin B12 status, hypomagnesemia, and reduced calcium bioavailability. These disturbances may negatively affect oxygen transport, neuromuscular function, energy metabolism, and bone mineral density. Observational studies suggest a modest increase in fracture risk and possible impairment in physical performance, although findings remain inconsistent and influenced by confounding factors. Chronic PPI use may therefore contribute to subtle but clinically relevant disturbances in micronutrient status and bone health, potentially affecting physical performance. However, given the predominantly observational nature of the evidence, conclusions should be interpreted cautiously. Regular reassessment of long-term PPI therapy and monitoring of nutritional and skeletal health may be warranted. Further prospective studies are needed to clarify causal relationships.
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