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Am J Gastroenterol. 2012 Sep;107(9):1361-9. doi: 10.1038/ajg.2012.200. Epub 2012 Jul 10.

The relationship between proton pump inhibitor use and longitudinal change in bone mineral density: a population-based study [corrected] from the Canadian Multicentre Osteoporosis Study (CaMos).

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University of Manitoba, Winnipeg, Manitoba, Canada.

Erratum in

  • Am J Gastroenterol. 2013 Jan;108(1):157.



Proton pump inhibitor (PPI) use has been identified as a risk factor for hip and vertebral fractures. Evidence supporting a relationship between PPI use and osteoporosis remains scant. Demonstrating that PPIs are associated with accelerated bone mineral density (BMD) loss would provide supportive evidence for a mechanism through which PPIs could increase fracture risk.


We used the Canadian Multicentre Osteoporosis Study data set, which enrolled a population-based sample of Canadians who underwent BMD testing of the femoral neck, total hip, and lumbar spine (L1-L4) at baseline, and then again at 5 and 10 years. Participants also reported drug use and exposure to risk factors for osteoporosis and fracture. Multivariate linear regression was used to determine the independent association of PPI exposure and baseline BMD, and on change in BMD at 5 and 10 years.


In all, 8,340 subjects were included in the baseline analysis, with 4,512 (55%) undergoing year 10 BMD testing. After adjusting for potential confounders, PPI use was associated with significantly lower baseline BMD at the femoral neck and total hip. PPI use was not associated with a significant acceleration in covariate-adjusted BMD loss at any measurement site after 5 and 10 years of follow-up.


PPI users had lower BMD at baseline than PPI non-users, but PPI use over 10 years did not appear to be associated with accelerated BMD loss. The reasons for discordant findings between PPI use at baseline and during follow-up require further study.

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Conflict of interest statement

Guarantor of the article: Laura E. Targownik, MD, MSHS. Specific author contributions: study concept and design, acquisition of database data, analysis and interpretation of data, drafting of the manuscript, critical revision of the manuscript for important intellectual content, and statistical analysis: Laura E. Targownik and William D. Leslie; acquisition of participant data, study concept and design, drafting of the manuscript, and critical revision of the manuscript for important intellectual content: K. Shawn Davison, David Goltzman, Sophie A. Jamal, Nancy Kreiger, Robert G. Josse, Stephanie M. Kaiser, Chris S. Kovacs, and Jerilynn C. Prior; acquisition of database data and statistical analysis: Wei Zhou. Financial support: Laura E. Targownik is supported by a CIHR/ Osteoporosis Canada New Investigator Award and the American College of Gastroenterology 2011 Clinical Research Award. Potential competing interests: William D. Leslie has served on advisory boards for Novartis, Amgen, and Genzyme; received unrestricted research grants from Merck Frosst, Genzyme, Amgen, Sanofi-Aventis, and Warner-Chilcott (formerly Procter & Gamble); received speaker fees from Merck Frosst and Amgen; received conference expenses from Genzyme. David Goltzman serves as a consultant for Eli Lily, Novartis, Merck, Proctor & Gamble, and Amgen. Sophie A. Jamal has been an advisory board member for Novartis, Amgen, and Warner-Chilcott; received consulting fees from Novartis, Warner-Chilcott, Genzyme, and Shire; speaker fees from Novartis, Amgen, Warner-Chilcott, Genzyme, and Shire. Christopher S. Kovacs serves as a consultant or has received honoraria from Amgen, Boehringer Ingelheim, Eli Lilly, Merck, and Novartis. Robert G. Josse serves as a consultant for Amgen, Bayer Corporation, Eli Lilly, GlaxoSmith-Kline, Merck, Novartis, Proctor & Gamble, Sanofi-aventis, Servier, and Wyeth-Ayerst. K. Shawn Davison has served as advisory board member/received honoraria from Amgen, Merck, Proctor & Gamble, Sanofi-aventis, and Servier. Stephanie M. Kaiser has served as advisory board member/received honoraria from Amgen, Eli Lilly, Novartis, Proctor & Gamble, Sanofi-aventis, Servier, and Wyeth-Ayerst. The remaining authors declare no conflict of interest.

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