Association between proton pump inhibitor use and muscle mass: a US population-based study

Proton pump inhibitors (PPIs) are widely prescribed, but their impact on muscle mass remains unclear. To investigate the association between PPI use and muscle mass among US adults, and to evaluate differences by PPI type, duration, indication, and subgroups. This cross-sectional study analyzed data from 18,629 adults in the National Health and Nutrition Examination Survey. PPI use was based on prescription data, and muscle mass was measured by DXA. Multivariable regression models were used assess the association between PPI use and muscle mass. Analyses of individual PPI types, dose–response by duration, indications for use, and subgroup differences were also conducted. Compared to non-users, PPI users had higher odds of low muscle mass (OR = 1.64; 95%CI 1.29–2.09). Esomeprazole (OR = 1.79, 95%CI 1.03–3.13) and lansoprazole (OR = 1.93, 95%CI: 1.17–3.18) showed significant associations with low muscle mass, whereas other PPIs did not. A dose–response relationship was observed, with each additional year of PPI use associated with a 7% increase in the odds of low muscle mass (OR = 1.07; 95%CI 1.04–1.11). Analyses by PPI indication did not reveal significant associations between specific indications and low muscle mass. Subgroup analyses revealed consistent associations across age, sex, and health status. PPI use may be associated with reduced muscle mass, particularly with esomeprazole and lansoprazole. Longer duration of PPI use appears to be associated with a greater likelihood of muscle mass decline. PPIs should be prescribed at the lowest effective dose and shortest duration.

• Publication year

  2026

• Venue

  Aging Clinical and Experimental Research

• Publication date

  2026-01-14

• Fields of study

  Medicine

• Identifiers
  DOI 10.1007/s40520-025-03311-1PMID 41530505PMCID 12872683
• External record

  Open on Semantic Scholar

• Source metadata

  Semantic Scholar, PubMed

• No claims are published for this paper.

• No concepts are published for this paper.

• Vitamin B12 status and skeletal muscle function among elderly: A literature review and pilot study on the effect of oral vitamin B12 supplementation in improving muscle function

  2024cited by this paper
• Gut microbiota, intestinal permeability, and systemic inflammation: a narrative review

  2023cited by this paper
• Proton pump inhibitors: Understanding the associated risks and benefits of long-term use.

  2023cited by this paper
• Epidemiology of sarcopenia: Prevalence, risk factors, and consequences.

  2023cited by this paper
• Evidence for proton-pump inhibitor (PPI)-associated dysbiosis in metabolically unhealthy obesity

  2023cited by this paper
• Independent Association Between Use of Proton Pump Inhibitors and Muscle Wasting in Patients with Heart Failure: A Single-Center, Ambispective, Observational Study

  2023cited by this paper
• Evolution of the consumption trend of proton pump inhibitors in the Lleida Health Region between 2002 and 2015

  2022cited by this paper
• Long term use of Proton Pump Inhibitor disrupts intestinal tight junction barrier and exaggerates experimental colitis.

  2022cited by this paper
• Inflammaging: Implications in Sarcopenia

  2022cited by this paper
• Overuse of medications in low- and middle-income countries: a scoping review

  2022cited by this paper
• Sarcopenia is Independently Associated with an Increased Risk of Peptic Ulcer Disease: A Nationwide Population-Based Study

  2020cited by this paper
• Functional dyspepsia is associated with lower exercise levels: A population-based study

  2020cited by this paper
• Association between skeletal muscle attenuation and gastroesophageal reflux disease: A health check-up cohort study

  2019cited by this paper
• Economic Impact of Hospitalizations in US Adults with Sarcopenia

  2019influential reference
• One week of magnesium supplementation lowers IL-6, muscle soreness and increases post-exercise blood glucose in response to downhill running

  2019cited by this paper
• Gut Dysbiosis and Muscle Aging: Searching for Novel Targets against Sarcopenia

  2018cited by this paper
• Important drug-micronutrient interactions: A selection for clinical practice

  2018cited by this paper
• Selected B vitamins and their possible link to the aetiology of age-related sarcopenia: relevance of UK dietary recommendations

  2018influential reference
• Evidence of Drug–Nutrient Interactions with Chronic Use of Commonly Prescribed Medications: An Update

  2018cited by this paper
• The Risks and Benefits of Long-term Use of Proton Pump Inhibitors: Expert Review and Best Practice Advice From the American Gastroenterological Association.

  2017influential reference
• Epidemiology of sarcopenia and insight into possible therapeutic targets

  2017cited by this paper
• Sarcopenic obesity or obese sarcopenia: A cross talk between age-associated adipose tissue and skeletal muscle inflammation as a main mechanism of the pathogenesis.

  2017cited by this paper
• Vitamin B12 deficiency might be related to sarcopenia in older adults

  2017influential reference
• Nutritional status, body composition, and quality of life in community-dwelling sarcopenic and non-sarcopenic older adults: A case-control study.

  2017cited by this paper
• Proton pump inhibitors alter the composition of the gut microbiota

  2015cited by this paper
• Magnesium in man: implications for health and disease.

  2015cited by this paper
• Proton pump inhibitors affect the gut microbiome

  2015cited by this paper
• Trends in Prescription Drug Use Among Adults in the United States From 1999-2012.

  2015cited by this paper
• The FNIH Sarcopenia Project: Rationale, Study Description, Conference Recommendations, and Final Estimates

  2014influential reference
• Prevalence, incidence, and clinical impact of sarcopenia: facts, numbers, and epidemiology—update 2014

  2014cited by this paper
• The roles of vitamin D in skeletal muscle: form, function, and metabolism.

  2013cited by this paper
• Proton pump inhibitors and risk of vitamin and mineral deficiency: evidence and clinical implications

  2013cited by this paper
• Improving the vitamin D status of vitamin D deficient adults is associated with improved mitochondrial oxidative function in skeletal muscle.

  2013cited by this paper
• What is Potent Acid Inhibition, and How Can it be Achieved?

  2012cited by this paper
• Systematic review: the use of proton pump inhibitors and increased susceptibility to enteric infection

  2011cited by this paper
• Proton Pump Inhibitors

  2008cited by this paper
• Review article: gastric acidity − comparison of esomeprazole with other proton pump inhibitors

  2003cited by this paper
• Gastric acid control with esomeprazole, lansoprazole, omeprazole, pantoprazole, and rabeprazole: a five-way crossover study

  2003cited by this paper
• The active site of pepsin is formed in the intermediate conformation dominant at mildly acidic pH

  2003cited by this paper
• Mechanism of activation of the gastric aspartic proteinases: pepsinogen, progastricsin and prochymosin.

  1998cited by this paper

• No citing papers are available for this paper.