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Numerous human studies show that gastric acid secretion aid in calcium absorption and that acid suppressants such as PPIs can decrease calcium absorption and decrease bone density.[203-210] An acidic environment in the stomach facilitates the release of ionized calcium from calcium salts, which is important for calcium absorption.[203-210] A number of conditions that cause hypochlorhydria are associated with an increased occurrence of osteoporosis and bone fracture, and it is assumed that this is secondary to the effect of low gastric acid levels on calcium absorption.[203-210] There were two large, case control studies from 2006 which led to considerable concern that chronic PPI use could lead to an increase in bone fractures and speculation of the possible mechanisms involved

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