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

BACKGROUND: Proton pump inhibitors (PPIs) are widely prescribed, but their impact on muscle mass remains unclear. AIMS: To investigate the association between PPI use and muscle mass among US adults, and to evaluate differences by PPI type, duration, indication, and subgroups. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.