The Association Between Prolonged Proton Pump Inhibitors Use and Bone Mineral Density

Figures & data

Table 1 Baseline Characteristics of Enrolled Proton-Pump Inhibitors (PPI) Users and PPI Non-users

Variables	PPI Users (n=133)	PPI Non-Users (n=261)	P Value
Age* (years)	48.3811.98	47.86	0.681
Female sex (%)	81.2	80.5	0.860
Body mass index * (Kg/m^2)	26.11	25.58	0.253
Smoking (%)	10.8	9.9	0.475
PPI used once daily (%)	90.3	0	–
PPI used twice daily (%)	9.7	0	–

Notes: *Mean ± Standard deviation; test: independent sample t-test.

Table 2 Age Distribution in Proton-Pump Inhibitor (PPI) Users and PPI Non-users

	PPI Users (%)	PPI Non-Users (%)	P Value
Age (years)
< 30	6 (4.5)	16 (6.1)	0.5122
30–39	25 (18.8)	46 (17.6)	0.7694
40–49	39 (29.3)	86 (33.0)	0.4556
50–59	38 (28.6)	67 (25.7)	0.5383
60–69	21 (15.8)	40 (15.3)	0.8967
>70	4 (3.0)	6 (2.3)	0.6760
Total	133 (100)	261 (100)

Table 3 Comparison of Dual-Energy X-Ray Absorptiometry-Derived Bone Mineral Density and Bone Mineral Content (BMC) Between Proton-Pump Inhibitor (PPI) Users and PPI Non-users

Variables*	PPI Users (n=133)	PPI Non-Users (n=261)	P Value
Lumbar spine BMC	0.92±0.24	1.05±0.17	<0.001
Lumbar spine T-Score	−1.20±2.17	−1.10±1.38	0.59
Lumbar spine Z-Score	−0.48±2.09	−0.71±1.23	0.19
Total hip BMC	0.82±0.12	0.94±0.12	<0.001
Total hip T-Score	−0.61±0.99	−0.53±1.06	0.49
Total hip Z-Score	−0.09±0.88	−0.18±0.93	0.37
Femoral neck BMC	0.70±0.11	0.87±0.13	<0.001
Femoral neck T-Score	−1.3±1.03	−0.84±1.08	<0.001
Femoral neck Z-Score	−0.65±0.85	−0.84±1.08	0.07

Note: *Mean ± Standard deviation.

Table 4 Dual-Energy X-Ray Absorptiometry-Derived Bone Mineral Density and Bone Mineral Content (BMC) in Proton-Pump Inhibitor (PPI) Users According to Physical Activity (N=133)

Variables*	Grade of Physical Activity** in PPI Users			P Value
	High (n=65)	Moderate (n=35)	Low (n=33)
Age (years)	48.12±13.23	48.49±12.00	48.78±9.26	0.97
Body mass index (Kg/m^2)	26.90±4.78	24.79±3.30	25.91 +4.56	0.07
Lumbar spine (L1–L4) BMC	52.61±24.42	53.26±10.34	54.90±13.97	0.79
Lumbar spine (L1–L4) T-Score	−1.13±2.81	−1.47±1.13	−1.08±1.41	0.35
Lumbar spine (L1–L4) Z-Score	−0.34±2.69	−0.80±1.16	−0.41±1.30	0.56
Total hip BMC	30.25±7.91	30.12±5.81	30.39±9.08	0.06
Total hip T-Score	−0.58±1.05	−0.69±0.81	−0.60±1.05	0.16
Total hip Z-Score	−0.13±0.92	−0.22±0.75	−0.11±0.93	0.66
Femoral neck BMC	3.63±0.76	3.50±0.51	3.71±0.92	0.27
Femoral neck T-Score	−1.37±1.11	−1.49±0.85	−1.30±1.07	0.27
Femoral neck Z-Score	−0.61±0.87	−0.77±0.72	−0.60±0.97	0.46

Notes: *Mean ± Standard deviation; test: ANOVA test. **Physical activity was classified as high grade if the participant walked at least 30 mins three times a week or run at least 30 mins two times per week, moderate if he/she walked between 15–30 mins between 1–3 times a week or run at least 30 mins one time per week, and low grade if they met none of the above criteria.

Table 5 Correlation of Duration of Proton-Pump Inhibitor Use with Dual-Energy X-Ray Absorptiometry-Derived Bone Mineral Content (BMC) and T Scores (N=133)

Variables*	r	P Value
Lumbar spine T-score	0.153	0.08
Lumbar spine BMC	0.209	0.02
Total hip T-score	−0.023	0.79
Total hip BMC	−0.003	0.97
Neck of femur T-score	−0.007	0.94
Neck of femur BMC	0.035	0.69

Note: *Test: Pearson's correlation.

Table 6 Dual-Energy X-Ray Absorptiometry-Derived Bone Mineral Density in Proton-Pump Inhibitor (PPI) Users According to the Duration of PPI Use (N=133)

Variables*	Duration of Use of PPI			P Value	Post Hoc Tukey
	2–5 Years (n=69)	5–10 Years (n=37)	>10 Years (n=27)
Age (years)	45.68±12.60	50.00±10.24	52.80±11.03	0.02	I vs. III
Body mass index (Kg/m^2)	25.99±4.94	26.94±3.75	25.53±3.92	0.44	–
Lumbar spine (L1-L4) T-Score	−1.33±1.11	−1.40±1.53	−0.46±4.25	0.19	–
Total hip T-Score	−0.60±0.92	−0.57±1.10	−0.66±1.04	0.94	–
Femoral neck T-Score	−1.36±0.95	−1.43±1.16	−1.36±1.08	0.95	–

Notes: *Mean ± Standard deviation; test: ANOVA.

Table 7 Frequency of Osteopenia/Osteoporosis* in Proton-Pump Inhibitor (PPI) Users and PPI Non-users

Variables**	PPI Users (n=133)	PPI Non-Users (n=261)	P Value
Lumbar spine osteopenia (%)	43.9	39.7	0.44
Lumbar spine osteoporosis (%)	18.2	16.3	0.65
Femoral neck osteopenia (%)	47.3	38.2	0.09
Femoral neck osteoporosis (%)	15.9	7.1	0.008

Notes: *The World Health Organization classification was used for definition of osteopenia (T-score: between −1.0 and −2.5) and osteoporosis (T-score ≤ −2.5). **Test: Chi-squared.