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

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 < 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 > 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.