Proton pump inhibitor exposure, trabecular bone score, and BMD: a registry-based cohort study
Authors' conclusion
In conclusion, PPI use is associated with greater SAD, an indicator of abdominal obesity. SAD and other clinical variables have a confounding effect on TBS and BMD measurements. When fully adjusted, PPI exposure did not significantly decrease TBS or BMD.
Study context
- Population
- Individuals with DXA (90.3% women, mean age 65.7 yr); 11,340 (18.6%) with proton pump inhibitors (PPI) use in the preceding 12 mo
- Participants
- 60,930 individuals
- Exposure
- PPI use vs non-use
- Outcome
- TBS (lowest tertile)
Main finding
As reported in the abstract
TBS in the lowest tertile, minimally adjusted for age, sex and scanner
Each group vs non-useOdds ratio (95% CI)
Minimal
1.11(1.02–1.22)
Mild
1.18(1.04–1.34)
Moderate
1.34(1.17–1.53)
High
1.41(1.31–1.52)
Observational data: associations, not effects.
Further findings
| Outcome | OR (95% CI) | |
|---|---|---|
| Osteoporotic BMD, minimally adjusted for age, sex and scannerMinimalvs Non-use | 0.97 (0.89–1.06) | |
| Osteoporotic BMD, minimally adjusted for age, sex and scannerMildvs Non-use | 0.85 (0.75–0.97) | |
| Osteoporotic BMD, minimally adjusted for age, sex and scannerModeratevs Non-use | 0.82 (0.72–0.94) | |
| Osteoporotic BMD, minimally adjusted for age, sex and scannerHighvs Non-use | 0.76 (0.70–0.82) | |
| 0.512Odds ratio (log scale) |
Osteoporotic BMD, minimally adjusted for age, sex and scanner
- After further adjustment for sagittal abdominal diameter (SAD), PPI use was not associated with lower BMD
Sagittal abdominal diameter (SAD)
- SAD greater in PPI users than non-users
Subgroups and duration
- Similar patterns in men and women, and for longer durations of PPI use
Trabecular bone score (TBS) or BMD loss on second DXA · mean interval 3.4 yr
- PPI use not associated with more rapid TBS or BMD loss vs non-users
- 4742 with a second DXA
Original publication
Proton pump inhibitor exposure, trabecular bone score, and BMD: a registry-based cohort study. J Bone Miner Res. Published 14 May 2025. doi:10.
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