Prevalence of Osteoporosis Among Chronic Proton Pump Inhibitor Users in Jordan: A Retrospective Cross-Sectional Study
Ahmed Rawshdeh(1) • Zaina Rawashdeh(2) • Ayham Alrawashdeh(3) • Mohammed Al-Shammari(4)
Published: June 18, 2026
Published in Springer Nature Journal: doi.org/10.click
Abstract
Background
Proton pump inhibitors (PPIs) are widely used for gastrointestinal conditions. Concerns exist regarding their long-term association with bone health, as reduced gastric acidity may impair calcium absorption and decrease bone mineral density (BMD). This study aimed to determine the prevalence of osteoporosis among chronic PPI users in Jordan and evaluate associations with reduced BMD.
Methods
A retrospective cross-sectional study was conducted at the University of Jordan Hospital (2019–2024). Patients aged ≥ 50 years who underwent dual-energy X-ray absorptiometry (DEXA) were included; secondary causes of osteoporosis were excluded. Demographics, body mass index (BMI), smoking status, family history of osteoporosis, and PPI use with duration were collected. T-scores at the lumbar spine (L1–L4), femoral neck, and total proximal femur were analyzed. Independent t-tests, chi-square tests, ANOVA for subgroup comparisons, and multivariable linear regression adjusting for age, sex, BMI, smoking, and PPI duration were applied, with p < 0.05 considered significant.
Results
A total of 1,412 patients (707 PPI users, 705 non-users) were included. Mean age was 62.3 years; females comprised 95.8% of participants. Median PPI duration was 10.5 years (range 1–20). No significant differences were observed between users and non-users in lumbar spine (p = 0.173), femoral neck (p = 0.234), or total proximal femur T-scores (p = 0.467). Multivariable regression confirmed no independent association between PPI use and lumbar spine T-score (adjusted β = -0.07, 95% CI -0.22 to 0.08, p = 0.361). Across PPI duration categories (1–5, 6–10, 11–15, 16–20 years), no significant differences in T-scores were observed (p = 0.412 for lumbar spine, p = 0.587 for femoral neck, p = 0.723 for total proximal femur). Subgroup analyses by age (< 65 vs. ≥65 years) and sex showed no significant associations. Obesity was more prevalent among non-users (25.5% vs. 19.9%, p = 0.029).
Conclusion
In this cohort, chronic PPI use was not significantly associated with reduced BMD after adjusting for major confounders. Given the retrospective cross-sectional design, causality cannot be inferred. Further prospective studies are warranted to explore dose-response relationships and fracture outcomes. Clinicians should remain cautious regarding unnecessary prolonged PPI use.