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. 2023 Dec 3;15(12):e49872. doi: 10.7759/cureus.49872

Table 1. The results of the literature review.

PTH - parathyroid hormone; PPI - proton pump inhibitors; HR - hazard ratio; OR - odds ratio; BP - bisphosphonate; H2RA - histamine-2 receptor antagonists; RR - relative risk; DXA - dual X-ray absorptiometry

Author, publication year Type of the study Number of participants Age Results
Hussain et al., 2018 [3] Systematic review and meta-analysis of case-control and cohort studies 1,270,418 >18 years RR: 1.26, 95% CI: 1.17-1.35, p<0.00001
Sharara et al., 2013 [4] Prospective matched controlled study 58 18-50 years No significant change in serum calcium,  phosphorus, PTH, 25-hydroxy vitamin D, osteocalcin, C-terminal cross-linked telopeptides of type I collagen (p>0.05) after 12 months of therapy
Hansen et al., 2019 [5] Prospective multicenter double-blind study 115 45-75 years No significant differences in changes in markers of bone turnover with PPI use
Fraser et al., 2013 [10] Cohort study 9,423 ≥25 years Adjusted HR for fracture 1.40, 95% CI: 1.11-1.77, p=0.004
Freedberg et al., 2015 [11] Case-control study 219,305 18-29 years Adjusted OR for the risk of fracture 1.39, 95% CI: 1.26-1.53 with a dose-response effect (p<0.001 for the trend)
Lauppe et al., 2019 [12] Retrospective cohort study 26,655 (20,398 general population, 6,257 DXA group (with prior fracture risk factors) 60-79 HR: 1.1, 95% CI: 1.0-1.1 in the general population; HR: 1.2, 95% CI: 1.1-1.3 in the DXA group
14,455 (12,755 general population, 1700 DXA group (with prior fracture risk factors) 80+ HR: 1.0, 95% CI: 1.0-1.1 in the general population; HR: 0.9, 95% CI: 0.8-1.1 in the DXA group
Lyu et al., 2020 [13] Retrospective study in kidney transplant recipients 1774 (1478 PPI users and 296  H2RA users) Average age of PPI users: 51.7 years; H2RA users: 45.7 years Decreasing slope of hip T-score for PPI vs. H2RA users: adjusted OR: 1.3, 95% CI: 0.8-1.9; decreasing slope of spine T-score for PPI vs. H2RA users: adjusted OR: 1.2, 95% CI: 0.8-1.8 (outcomes measured three months after transplant, which remained statistically similar six months after transplant) 
Mortensen et al., 2020 [14] Systematic review and meta-analysis 352,366 (297,488 controls and 54,878 cases) Average age ≥43 years OR: 1.29, 95% CI: 1.13-1.47, p<0.001
Ozen et al., 2019 [15] Longitudinal prospective observational study   4963 ≥40 years Adjusted HR: 0.92, 95% CI: 0.80-1.06
Zirk- Sadowski et al., 2017 [16] Retrospective cohort study 172,938 (86,469 treatment group and 86,469 control group) 60-74 years Adjusted HR: 1.35, 95% CI: 1.13-1.59  
75-84 years Adjusted HR: 1.22, 95% CI: 0.96-1.39
85+ years Adjusted HR: 1.11, 95% CI: 0.86-1.41
Itoh et al., 2013 [17] Randomized controlled trial 180 >50 years % increase in bone mineral density (average±SD), p<0.05 in BP group: 12.4±19.6, in PPI+BP group: 24.6±27.4
% decrease in bone-specific alkaline phosphatase (average±SD), p<0.01 in BP group: 31.9±26.0, in PPI+BP group: 16.4±28.1