Association between long-term proton pump inhibitor use and bone mineral density among Jordanian adults: A retrospective study

Osteoporosis is a common skeletal disease that is defined by low bone density and an increased risk of fracture. It is a widespread health issue with significant health consequences that has recently attracted the attention of the worldwide community. The present research was carried out to test the association between prolonged PPI therapy and bone mineral density among patients in Jordan.

A retrospective observational study was performed at Al-Zarqa New Governmental and Al-Basheer Hospitals, Jordan. A total of 695 patients aged 20-60 years who underwent dual-energy X-ray absorptiometry (DEXA) were divided into 3 groups: long-term users of PPIs (≥ 12 months), famotidine users (≥ 12 months), and non-users. Bone mineral density (BMD) at the lumbar spine and femoral neck was measured using T- and Z-scores adjusted for age and sex.

Of 695 participants, 180 (25.9%) were PPI users, 105 (15.1%) famotidine users, and 410 (59%) non-exposed group. The median age was 53 years, and 90.4% were female. No significant differences were found in femoral neck or lumbar spine BMD and Z-scores between groups. In the T-score group, the lumbar spine T-score differed significantly across groups (p = 0.040), driven by differences between non-exposed group and famotidine users (p = 0.034), with no significant differences involving PPI users.

Our study provides the literature with unique results in support of the safety of long-term PPI use in terms of BMD. Further research is needed to explore this relationship in more robust study designs that address potential bias and confounding factors and explore it in a healthy population.