Prevalence of Osteoporosis Among Chronic Proton Pump Inhibitor Users in Jordan: A Retrospective Cross-Sectional Study

Prevalence of Osteoporosis Among Chronic Proton Pump Inhibitor Users in Jordan: A Retrospective Cross-Sectional Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Prevalence of Osteoporosis Among Chronic Proton Pump Inhibitor Users in Jordan: A Retrospective Cross-Sectional Study Ahmed Rawshdeh, Zaina Rawashdeh, Ayham Alrawashdeh, Mohammed Al-shammari This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8238497/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 9 You are reading this latest preprint version Abstract Background Proton pump inhibitors (PPIs) are widely used for gastrointestinal conditions. Concerns exist regarding their long-term impact on 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 We conducted a retrospective cross-sectional study 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, and ANOVA for subgroup comparisons were applied, with p 90% of participants. Median PPI duration was 10 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). Obesity was slightly higher among non-users (25.5% vs. 19.9%, p = 0.029). Smoking and family history did not differ. Subgroup analysis by PPI duration revealed no significant differences in T-scores. Conclusion Chronic PPI use was not significantly associated with reduced BMD. About half of osteoporosis patients were long-term PPI users, but T-scores were comparable to non-users. Further prospective studies are warranted to explore dose-response relationships and fracture outcomes. Clinicians should remain cautious regarding unnecessary prolonged PPI use. Bone Mineral Density Chronic Medication Use DEXA Scan Osteoporosis Proton Pump Inhibitors Full Text Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 12 Mar, 2026 Reviews received at journal 09 Mar, 2026 Reviewers agreed at journal 06 Mar, 2026 Reviews received at journal 25 Feb, 2026 Reviewers agreed at journal 24 Feb, 2026 Reviewers invited by journal 18 Feb, 2026 Editor assigned by journal 08 Dec, 2025 Submission checks completed at journal 08 Dec, 2025 First submitted to journal 29 Nov, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8238497","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":594097596,"identity":"71315a1e-cb98-4fcf-8759-0838b0dc9d14","order_by":0,"name":"Ahmed Rawshdeh","email":"","orcid":"","institution":"Jordanian Royal Medical Services","correspondingAuthor":false,"prefix":"","firstName":"Ahmed","middleName":"","lastName":"Rawshdeh","suffix":""},{"id":594097597,"identity":"aadb0b85-7360-428a-8c49-e9b8a67f2ffb","order_by":1,"name":"Zaina Rawashdeh","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA8klEQVRIie2RIYvDMBSAXyh05rHYlJbbX8iYOTF2vyUEbqaisjKjkJnA7H7Gzkx3VJy5H3BwE62pmjgZMXHpzQ26Vk7kE4EH74P3EQCP5ykhyj0lTiHY1L8cEjfxcUoIpJjvOeAI5Z8SnKJjtz+szLaVri2ck3ByUvEyWyFl8gA2P/afZcR2bqDFEIVapFxitH/PiPn66VUCEJohVK5FKJnyEvl3ygOi+5WQNjq6dgptVPU6RkEmumqnMLEpYIzCWKPjhLsW1hTEdC2mzU6PWma7dRtd8vMbpfLT2uvqhU7kR23zfuXG/UeUA/sej8fjGeAPwNROYgUrrpwAAAAASUVORK5CYII=","orcid":"","institution":"University of Jordan","correspondingAuthor":true,"prefix":"","firstName":"Zaina","middleName":"","lastName":"Rawashdeh","suffix":""},{"id":594097598,"identity":"bb09dc8f-a943-42e1-b601-95d19b74636f","order_by":2,"name":"Ayham Alrawashdeh","email":"","orcid":"","institution":"Jordanian Royal Medical Services","correspondingAuthor":false,"prefix":"","firstName":"Ayham","middleName":"","lastName":"Alrawashdeh","suffix":""},{"id":594097599,"identity":"d40db725-70c8-47de-ae44-afac2d3447c1","order_by":3,"name":"Mohammed Al-shammari","email":"","orcid":"","institution":"Baghdad Medical City","correspondingAuthor":false,"prefix":"","firstName":"Mohammed","middleName":"","lastName":"Al-shammari","suffix":""}],"badges":[],"createdAt":"2025-11-29 17:23:13","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8238497/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8238497/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":103504560,"identity":"a5e4ccb9-b09a-4c54-850b-e167cd95b1cf","added_by":"auto","created_at":"2026-02-26 13:20:34","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":710486,"visible":true,"origin":"","legend":"","description":"","filename":"PPI.Blinded2.V.2..pdf","url":"https://assets-eu.researchsquare.com/files/rs-8238497/v1_covered_19b9e9ca-e0fa-4659-921b-67c28a6143e4.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Prevalence of Osteoporosis Among Chronic Proton Pump Inhibitor Users in Jordan: A Retrospective Cross-Sectional Study","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"sn-comprehensive-clinical-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"sncm","sideBox":"Learn more about [SN Comprehensive Clinical Medicine](https://www.springer.com/journal/42399)","snPcode":"42399","submissionUrl":"https://submission.nature.com/new-submission/42399/3","title":"SN Comprehensive Clinical Medicine","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Bone Mineral Density, Chronic Medication Use, DEXA Scan, Osteoporosis, Proton Pump Inhibitors","lastPublishedDoi":"10.21203/rs.3.rs-8238497/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8238497/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eProton pump inhibitors (PPIs) are widely used for gastrointestinal conditions. Concerns exist regarding their long-term impact on 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.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eWe conducted a retrospective cross-sectional study at the University of Jordan Hospital (2019\u0026ndash;2024). Patients aged\u0026thinsp;\u0026ge;\u0026thinsp;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\u0026ndash;L4), femoral neck, and total proximal femur were analyzed. Independent t-tests, chi-square tests, and ANOVA for subgroup comparisons were applied, with p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 considered significant.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eA total of 1,412 patients (707 PPI users, 705 non-users) were included. Mean age was 62.3 years; females comprised\u0026thinsp;\u0026gt;\u0026thinsp;90% of participants. Median PPI duration was 10 years (range 1\u0026ndash;20). No significant differences were observed between users and non-users in lumbar spine (p\u0026thinsp;=\u0026thinsp;0.173), femoral neck (p\u0026thinsp;=\u0026thinsp;0.234), or total proximal femur T-scores (p\u0026thinsp;=\u0026thinsp;0.467). Obesity was slightly higher among non-users (25.5% vs. 19.9%, p\u0026thinsp;=\u0026thinsp;0.029). Smoking and family history did not differ. Subgroup analysis by PPI duration revealed no significant differences in T-scores.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eChronic PPI use was not significantly associated with reduced BMD. About half of osteoporosis patients were long-term PPI users, but T-scores were comparable to non-users. Further prospective studies are warranted to explore dose-response relationships and fracture outcomes. Clinicians should remain cautious regarding unnecessary prolonged PPI use.\u003c/p\u003e","manuscriptTitle":"Prevalence of Osteoporosis Among Chronic Proton Pump Inhibitor Users in Jordan: A Retrospective Cross-Sectional Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-20 16:50:47","doi":"10.21203/rs.3.rs-8238497/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-03-12T05:48:54+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-10T00:03:39+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"189362250654026206067499341064864551444","date":"2026-03-06T09:44:01+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-25T10:51:28+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"66075362057778935399068464293881582207","date":"2026-02-24T09:13:22+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-02-18T15:28:37+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-12-09T02:04:38+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-12-09T00:31:26+00:00","index":"","fulltext":""},{"type":"submitted","content":"SN Comprehensive Clinical Medicine","date":"2025-11-29T17:14:49+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"sn-comprehensive-clinical-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"sncm","sideBox":"Learn more about [SN Comprehensive Clinical Medicine](https://www.springer.com/journal/42399)","snPcode":"42399","submissionUrl":"https://submission.nature.com/new-submission/42399/3","title":"SN Comprehensive Clinical Medicine","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"9deef175-3665-42f2-8b43-a7bcf609213e","owner":[],"postedDate":"February 20th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-18T09:39:06+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-20 16:50:47","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8238497","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8238497","identity":"rs-8238497","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}