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
All of the following adverse effects are associated with the use of proton pump inhibitors except: 
Select and explain. 
A. Community acquired pnemonia, B. Clostridium difficile infection, C. Osteoporosis leading to hip fractures, D. Hypothyroidism
D: Hypothyroidism
Answer: D: Hypothyroidism 
Explanation: 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)