This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: Gastrointestinal tract, Subject name: Pharmacology
[{'content': 'All of the following adverse effects are associated with the use of proton pump inhibitors except: \nSelect and explain. \nA. Community acquired pnemonia, B. Clostridium difficile infection, C. Osteoporosis leading to hip fractures, D. Hypothyroidism', 'role': 'user'}, {'content': 'Answer: D \nExplanation: Long term use of proton pump inhibitors may lead to : -Mild to moderate decrease in vitamin B12,iron and calcium absorption. -increased risk of enteric infections including C.difficile and bacterial gastroenteritis. -modest increase in risk of hip fractures. -modest increase in risk of pnemonia. (Ref.CMDT 2015/609-610)', 'role': 'assistant'}]