Long-term PPI use in older patients on of high dosages has also been associated with an increased risk of hip fractures through the presumed inhibition of calcium absorption by PPl induced hypochlorhydria or through inhibition of proton pumps within the osteoclastic vacuole resulting in decreased bone resorption . Although the overall risk was low and was statistically significant, data from previous studies reported normal calcium absorption in patients on PPIs for at least 4 years. Long- term PPI use has also been modestly associated with fractures of the spine, forearm, and wrist. Additional studies are required to confirm a causal relationship between long-term PPIs and bone fractures and at this time additional bone density testing and calcium supplementation are not suggested beyond age-related recommendations