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There are currently over a dozen published manuscripts evaluating the relationship between proton pump inhibitors (PPIs) and the occurrence of osteoporotic fractures, in particular, fractures of the hip.1 In the majority of instances, a modest yet significant association between PPI use and hip fracture was detected. However, many of the previous studies were not able to control for potentially relevant confounders, including dietary intake of calcium and vitamin D, smoking and alcohol use, body mass index (BMI) and level of physical activity.
Khalili et al detail their analysis of 79 899 postmenopausal female participants from the Nurses' Health Study. In this dataset, women were interviewed regarding medical illness, use of medications (including PPIs from 2000 onwards), diet and level of physical activity. Cox proportional hazards models were constructed controlling for age, BMI, calcium and vitamin D intake, smoking, alcohol use, physical activity and …
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