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Several population studies have suggested a weak association between proton pump inhibitor (PPI) use and hip fractures (e.g., NEJM JW Gastroenterol Jul 2010 and Arch Intern Med 2010; 170:765); however, strong evidence of causality and a clear mechanism for this effect are lacking. Investigators in Manitoba assessed bone strength and structure in 52 patients with >5 years of PPI use compared with 52 matched nonusers (mean overall age, 65). Areal bone mineral density (BMD) and associated T-scores were determined with DXA scanning; bone structure was evaluated with three-dimensional quantitative computed tomography (3D-QCT) for volumetric BMD (vBMD) and cortical bone mineral mass. Metabolic markers of bone turnover and osteoblast activity were…