**3. Proton-pump inhibitors and risk of fractures**

PPIs are among the most frequently recommended treatments worldwide in clinical practice. Although the majority of patients handle PPIs well overall, there is growing concern over a possible link between PPI use and an increased risk of bone fracture [11, 12]. Indeed, the correlation between PPI medication and the incidence of fracture has been documented in numerous observational studies [13–15]. The findings of each study differ significantly from one another. According to meta-analyses of the evidence, PPI medication is often linked to a higher risk of fracture [16–20]. The Food and Drug Administration (FDA) also issued a safety advisory in May 2010 addressing a potential increase in fracture risk of hip, wrist, and spine fractures associated with PPI usage and recommended that no more than three 14-day treatment sessions should be taken in a year, based on seven epidemiologic studies and claims data base analysis (no randomized trials), while they recognized that additional data were required [18].
