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We appreciate the interest shown by Dr Sugiyama1 concerning our recent study on medications associated with fracture risk in patients with rheumatoid arthritis (RA).2 He emphasises the lack of association between proton pump inhibitor (PPI) use and fracture risk in patients with RA, which has been a conflicting issue for the general population. We agree that the previous studies showing an increased fracture risk with PPIs in the general population may be confounded by the indication as it is known that PPI …
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