Researchers studied how a popular stomach medication called proton-pump inhibitors (PPIs) affects bone health in older people. They followed 189 adults over two years, comparing 24 people who regularly took PPIs with 165 who didn’t. Using advanced imaging technology, they found that people taking PPIs lost more bone density and strength in their legs and arms compared to those not taking the medication. The bones also developed more tiny holes and became more fragile. This research helps explain why some studies have shown that people on these medications have more broken bones.

The Quick Take

  • What they studied: Whether taking stomach acid-reducing pills (PPIs) for a long time makes bones weaker and more likely to break in older adults
  • Who participated: 189 people aged 60 and older, with 24 regularly taking PPIs and 165 not taking them. Both groups started out with similar bone health and were tracked for 2 years
  • Key finding: People taking PPIs lost significantly more bone density and strength in their leg bones compared to those not taking the medication. Their arm bones also developed more tiny holes, making them more fragile
  • What it means for you: If you take PPIs regularly, talk to your doctor about your bone health. You may benefit from bone density screening, calcium and vitamin D intake, and weight-bearing exercise. Don’t stop taking your medication without medical guidance, but discuss alternatives with your healthcare provider

The Research Details

This was a careful study that followed the same people over 2 years. Researchers took detailed pictures of bones in the leg and arm at the beginning and end using special high-resolution imaging technology (like a very detailed CT scan). This technology is much better than older bone-scanning methods because it can see the tiny structures inside bones, not just overall density.

The study compared two groups: people who regularly took stomach acid-reducing medications (PPIs) and people who didn’t take them. Both groups were similar in age, weight, and starting bone health, which makes the comparison fair. Researchers measured changes in bone density, bone structure, and bone strength over the 2-year period.

The study was part of a larger vitamin D research project, which helped ensure good quality data collection and follow-up. This design allowed researchers to see real changes happening in bones over time, rather than just taking a snapshot at one moment.

Previous studies suggested PPIs might weaken bones, but older imaging methods couldn’t show exactly how or why. This study uses advanced technology that reveals the actual structure of bones at a microscopic level. By seeing these detailed changes, researchers can better understand the mechanism of bone damage and help doctors make better recommendations for patients who need these medications long-term

This study has several strengths: it followed real people over time (rather than just observing them once), used the most advanced bone imaging available, and carefully controlled for other factors that affect bones like age, weight, and sex. However, the study had a relatively small number of PPI users (24 people), which means the findings need confirmation in larger studies. The study was part of a vitamin D trial, which adds credibility to the research methods

What the Results Show

People taking PPIs lost bone density in their leg bones much faster than those not taking the medication. Specifically, they lost about 3.5 times more total bone density in the lower leg (8.58 vs 2.45 units) and about twice as much in the hard outer layer of bone (28.96 vs 14.07 units). These differences were statistically significant, meaning they’re unlikely to be due to chance.

Bone strength also declined more in PPI users. Their leg bones became about 4,800 units weaker in stiffness (ability to resist bending) and could handle about 200 units less force before breaking, compared to minimal changes in non-users. These changes suggest bones became noticeably more fragile.

In the arm bones, PPI users developed more tiny holes in the hard outer layer of bone (cortical porosity). These holes were also larger in diameter. Think of it like a sponge developing more and bigger air pockets, which makes it weaker. This happened significantly more in PPI users than in those not taking the medication.

All of these changes occurred over just 2 years, suggesting that the effect of PPIs on bone happens relatively quickly in older adults.

The study found that the harmful effects on bone were consistent across different measurements and locations. The damage wasn’t limited to just one type of bone or one area of the body—it affected both the dense outer layer and the overall structure. This suggests PPIs have a broad effect on bone quality, not just one specific mechanism. The fact that changes appeared in both the leg and arm bones indicates this is a systemic effect affecting the whole skeleton

Earlier research had shown that people taking PPIs have more broken bones, but scientists weren’t sure exactly why. This study provides the missing piece by showing the actual bone damage that occurs. Previous studies used older imaging methods (DXA scans) that only measure overall bone density. This research uses much more detailed imaging that reveals the microscopic structure of bones, explaining why people on PPIs break bones more easily even if their overall bone density looks okay on older tests

The study had some important limitations to consider. First, only 24 people were regular PPI users, which is a small number. Larger studies are needed to confirm these findings. Second, the study only lasted 2 years, so we don’t know if the bone loss continues at the same rate longer-term or if it eventually stops. Third, the study didn’t measure how long people had been taking PPIs before the study started—some may have been on them for years while others for months. Finally, the study measured bones in the leg and arm but not the spine or hip, where fractures are most common in older adults

The Bottom Line

If you regularly take PPIs: (1) Talk to your doctor about whether you still need the medication or if alternatives exist—moderate confidence, as some people need PPIs for serious conditions. (2) Get a bone density screening if you haven’t had one recently—moderate to high confidence based on this research. (3) Ensure adequate calcium (1000-1200 mg daily) and vitamin D (800-1000 IU daily)—high confidence, as these are standard recommendations for older adults. (4) Do weight-bearing exercise like walking or strength training—high confidence for bone health. (5) Avoid smoking and limit alcohol—high confidence for bone health

This research is most relevant to people over 60 who take PPIs regularly (daily or nearly daily). It’s especially important for those with risk factors for osteoporosis like being female, having a family history of fractures, or being thin. People who need PPIs for serious conditions like severe reflux or ulcers should not stop taking them without medical guidance but should discuss bone health with their doctor. Younger people taking PPIs occasionally are at lower risk. Healthcare providers should consider this research when deciding whether to continue long-term PPI therapy

Bone loss from PPIs appears to happen relatively quickly—this study found significant changes in just 2 years. However, benefits from interventions like exercise and better nutrition take longer. You might notice improved energy and strength from exercise within 4-6 weeks, but bone density improvements typically take 6-12 months to measure. If you make changes based on this research, ask your doctor about repeat bone density testing in 1-2 years to see if the rate of bone loss has slowed

Want to Apply This Research?

  • Track daily calcium and vitamin D intake (target: 1000-1200 mg calcium, 800-1000 IU vitamin D). Log weekly weight-bearing exercise sessions (walking, strength training, dancing). Record any falls or injuries to identify patterns
  • If you take PPIs regularly, use the app to: (1) Set reminders to take calcium and vitamin D supplements with meals, (2) Schedule and track 150 minutes of weight-bearing exercise weekly, (3) Log medication use to discuss with your doctor at appointments, (4) Set a reminder to ask your doctor about bone density screening
  • Create a quarterly check-in to review bone health metrics: calcium/vitamin D intake consistency, exercise frequency, any new aches or pains, and medication changes. Set an annual reminder to discuss bone health with your doctor and schedule bone density testing every 1-2 years if recommended

This research suggests a link between long-term PPI use and bone weakening in older adults, but individual results vary. Do not stop taking prescribed PPIs without consulting your doctor, as they may be necessary for your health. If you take PPIs regularly, discuss this research with your healthcare provider to determine if you need bone density screening, additional calcium and vitamin D, or alternative medications. This information is educational and not a substitute for professional medical advice. People with specific health conditions, those taking other medications, or those with a history of bone disease should have personalized discussions with their healthcare team before making changes based on this research.