PTSD occurs in a significant percentage of subjects who recover from SARS, and the occurrence of PTSD predicts persistent psychological distress and diminished social functioning in the 4 years after SARS treatment.

Background-Physical activity (PA) is an important modifiable risk factor for both bone mineral density (BMD) and body mass index (BMI). However, BMI is itself strongly predictive of BMD. Our aim was to determine the association between PA and BMD, with consideration of BMI as a potential mediating factor.

OBJECTIVES-Proton pump inhibitor (PPI) use has been identified as a risk factor for hip and vertebral fractures. Evidence supporting a relationship between PPI use and osteoporosis remains Correspondence: Laura E. Targownik, MD, MSHS, Gastroenterology, University of Manitoba, 805G-715 McDermot Avenue, Winnipeg, Manitoba, Canada R3E 3P4. targowni@cc.umanitoba.ca. 8 See Appendix. CONFLICT OF INTERESTGuarantor of the article: Laura E. Targownik, MD, MSHS. Specific author contributions: study concept and design, acquisition of database data, analysis and interpretation of data, drafting of the manuscript, critical revision of the manuscript for important intellectual content, and statistical analysis: Laura E. Targownik and William D. Leslie; acquisition of participant data, study concept and design, drafting of the manuscript, and critical revision of the manuscript for important intellectual content: K. Shawn Davison, David Goltzman, Sophie A. Jamal, Nancy Kreiger, Robert G. Josse, Stephanie M. Kaiser, Chris S. Kovacs, and Jerilynn C. Prior; acquisition of database data and statistical analysis: Wei Zhou. CIHR Author ManuscriptCIHR Author Manuscript CIHR Author Manuscript scant. Demonstrating that PPIs are associated with accelerated bone mineral density (BMD) loss would provide supportive evidence for a mechanism through which PPIs could increase fracture risk.METHODS-We used the Canadian Multicentre Osteoporosis Study data set, which enrolled a population-based sample of Canadians who underwent BMD testing of the femoral neck, total hip, and lumbar spine (L1-L4) at baseline, and then again at 5 and 10 years. Participants also reported drug use and exposure to risk factors for osteoporosis and fracture. Multivariate linear regression was used to determine the independent association of PPI exposure and baseline BMD, and on change in BMD at 5 and 10 years.RESULTS-In all, 8,340 subjects were included in the baseline analysis, with 4,512 (55%) undergoing year 10 BMD testing. After adjusting for potential confounders, PPI use was associated with significantly lower baseline BMD at the femoral neck and total hip. PPI use was not associated with a significant acceleration in covariate-adjusted BMD loss at any measurement site after 5 and 10 years of follow-up.CONCLUSIONS-PPI users had lower BMD at baseline than PPI non-users, but PPI use over 10 years did not appear to be associated with accelerated BMD loss. The reasons for discordant findings between PPI use at baseline and during follow-up require further study.

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