The magnitude of the association is modest and is most likely due to confounding factors as patients prescribed PPI therapy  tend to be more frail with more risk factors for fractures than those not given these drugs .
There is no clear dose – response relationship and there is no association between PPI therapy and risk of fracture in those at highest risk .
Finally , there is no clear mechanism through which PPI therapy increases the risk of fracture , as recent r and omized trials show no impact of PPI therapy on calcium absorption and there is no association between PPI therapy and risk of osteoporosis .
We therefore feel there is insufficient evidence to change PPI prescribing habits based on risk of fracture .
There is no evidence to support prescription of calcium and /or vitamin D in patients simply because they are taking PPI therapy .
Does frailty predict increased risk of falls and fractures? A prospective population-based study
Summary A frailty concept that includes psychological and cognitive markers was prospect ively shown to be associated with increased risk of multiple falls and fractures among 1,509 community dwelling older adults , especially in those aged 75 and over . The predictive ability of frailty is not superior to falls history . Introduction The concept of frailty has been defined with or without psychological and cognitive markers . Falls are associated with multiple risk factors , including cognitive and mood disorders . The purpose of this study was to investigate the association of a comprehensive concept of frailty and its components with falls and fractures in community-dwelling older adults and to compare its predictive ability with having a history of falls . Methods One thous and five hundred nine participants in the Longitudinal Aging Study Amsterdam aged ≥65 were assessed to determine fall history and the prevalence of nine frailty markers , including cognitive and psychological factors . The number of falls and time to second fall were prospect ively registered for 1 year . Fractures were registered for 6 years . Results Frailty was significantly associated with time to second fall : hazard ratio of 1.53 [ 95 % confidence interval ( CI ) , 1.07–2.18 ] and area under the receiver operating characteristic curve ( AUC ) of 0.58 ( CI , 0.53–0.62 ) . In participants aged ≥75 , frailty was associated with ≥2 falls : odds ratio ( OR ) of 1.74 ( CI , 1.19–2.55 ) and AUC of 0.62 ( CI , 0.55–0.68 ) . Frailty , adjusted for age and sex , was significantly associated with ≥2 fractures : OR of 3.67 ( CI , 1.47–9.15 ) . The AUCs for falls history ( aged ≥75 ) ranged from 0.62 ( CI , 0.58–0.67 ) for ≥1 falls to 0.67 ( CI , 0.59–0.74 ) for ≥3 falls . Conclusions A concept of frailty including psychological and cognitive markers is associated with both multiple falls and fractures . However , frailty is not superior to falls history for the selection of old persons at increased risk of recurrent falls
The magnitude of the association is modest and is most likely due to confounding factors as patients prescribed PPI therapy  tend to be more frail with more risk factors for fractures than those not given these drugs .
There is no clear dose – response relationship and there is no association between PPI therapy and risk of fracture in those at highest risk .
Finally , there is no clear mechanism through which PPI therapy increases the risk of fracture , as recent r and omized trials show no impact of PPI therapy on calcium absorption and there is no association between PPI therapy and risk of osteoporosis .
We therefore feel there is insufficient evidence to change PPI prescribing habits based on risk of fracture .
There is no evidence to support prescription of calcium and /or vitamin D in patients simply because they are taking PPI therapy .