Hypochlorhydric stomach: a risk condition for calcium malabsorption and osteoporosis?

Abstract

Malabsorption of dietary calcium is a cause of osteoporosis. Dissolution of calcium salts (e.g. calcium carbonate) in the stomach is one step in the proper active and passive absorption of calcium as a calcium ion (Ca²⁺) in the proximal small intestine. Stomach acid markedly increases dissolution and ionization of poorly soluble calcium salts. If acid is not properly secreted, calcium salts are minimally dissolved (ionized) and, subsequently, may not be properly and effectively absorbed. Atrophic gastritis, gastric surgery, and high-dose, long-term use of antisecretory drugs markedly reduce acid secretion and may, therefore, be risk conditions for malabsorption of dietary and supplementary calcium, and may thereby increase the risk of osteoporosis in the long term.

Key Words::

• Achlorhydria
• atrophic gastritis
• calcium carbonate
• calcium salt
• hypochlorhydria
• malabsorption
• osteoporosis
• proton-pump inhibitor
• stomach acid

Acknowledgements

P. S. and M. H. are scientific advisors and shareholders of Biohit Oyj (Helsinki, Finland). Biohit Oyj develops and markets laboratory pipettes and laboratory tests, including GastroPanel^® and GastroView^® tests, which are the commercially available biomarker tests for atrophic gastritis mentioned in the paper.