Risk of osteoporosis and osteopenia in patients with prolonged use of proton pump inhibitors

Background and aim of the work: Several studies suggest that proton pump inhibitors [PPIs] use may be involved in development and acceleration of osteoporosis. The aim of this study is to investigate the relationships between prolonged uses of PPIs in patients with gastro-esophageal reflux disease [GERD] and to reveal their possible role in development of osteopenia or osteoporosis with evaluation of different diagnostic tools which help in follow up of those patients

Patient and methods: This prospective controlled study which was conducted at King Abdul Aziz Specialist Hospital in Taif, Saudi Arabia, from January 2013 to June 2016. We compared the prevalence of osteoporosis or osteopenia in 2 groups of individuals, the first group; of 30 patients using PPIs as treatment of GERD for more than 2 years. The second group included thirty healthy control subjects .In both groups we measured the bone mineral density using the dual energy X-ray absorptiometry [DEXA], calcium [Ca], inorganic phosphorus [P], serum alkaline phosphatase, and deoxypyridinoline [DPD] in urine

Results: there were no significant differences between the 2 groups as regards, age, gender, and their clinical history [P > 0.05], however, the history of fragility fracture was significantly higher in PPIs group of patients [P< 0.05]. The means of antroposterior spine and left femur BMD-T scores were lower than normal in both groups; however, it was significantly lower in PPIs group than in control group [P< 0.05]. Serum calcium was slightly lower than the reference range with normal phosphorus level without significant difference between both groups [P> 0.05]. The serum alkaline phosphatase and urinary DPD were higher than normal reference levels, but, significantly higher in patients receiving PPIs [P< 0.05]. The number of osteopenic/osteoporotic patients was significantly higher in PPIs group than in control group [P< 0.05]. Osteopenia and osteoporosis were significantly correlated in PPIs group with male gender, younger age group of patients [P< 0.05], and the correlation was highly significant with the duration of use of the drug [P<0.001]. In control group the decrease in bone density was significantly correlated with the female gender and to older group of patients [P< 0.05]

Conclusion: in GERD patient using PPIs, the osteopenic/osteoporotic effect with increased possibility of fragility fractures must be discussed with the patient if prolonged use of these drugs is expected, taking in consideration the potential safety and reliability of laparoscopic or thoracoscopic surgical options as alternative therapy

Fixation of undisplaced fractures of the neck of femur with multiple cannulated screws

Treatment of fracture neck of the femur varies according to patient's age and the pattern of the fracture. Multiple cannulated screws [MCS] have been commonly used to treat femoral neck fractures. In this retrospective study we evaluated the outcome of the use of this technique in the treatment of undisplaced fracture neck of femur. In this retrospective chart review study, we revised the files and medical records of the cases of stable fracture neck of femur which had been treated by MCS in patients who were admitted to King Abdul Aziz Specialist Hospital and King Faisal Hospital, Al Taif, Saudi Arabia from January 2007 to December 2011. Sixteen patients with impacted and undisplaced fracture of the neck of femur were treated with multiple cannulated screws. The mean follow up was 26 months; mean age was 38 years [range 14-58 years]. Thirteen/16 patients [81.25%] were satisfied with the excellent results of the treatment. Two patients [12.5%] showed non- union and valgus osteotomy, compression of the fracture and rigid internal fixation were used to promote union. One case developed avascular necrosis and treated by total hip Arthroplasty. Fixation with cannulated screws usually is adequate for most femoral neck fractures specially the undisplaced type with acceptably low incidence of complications

Diagnostic and screening utility of biochemical markers for osteoporosis and osteopenia in Saudi women

Postmenopausal osteoporosis is a major health problem worldwide and in Saudi Arabia as it leads to bone fragility and increased liability for fragile fractures, particularly in neck of femur and vertebrae. The present study was designed to determine the value of different screening tests to find out the most sensitive serum and urinary markers of osteoporosis among Saudi women and to clarify the relationship between E[2] deficiency and these markers in peri-menopause, early or postmenopausal women without hormonal replacement therapy. This study included 37 Saudi women aged 40 to 60 years. They were categorized into 3 groups according to their bone mineral density [BMD]: Group I: 15 Normal control [T-score up to -1.5], Group II: 12 Osteopenic women [T-score between -1.5 to 2.5]and Group III:10 Osteoporotic women [T-score below 2.5]. For all subjects, dual energy X-ray absorptiometry [DEXA] was performed. Osteocalcin [OC], alkaline phosphatase [ALP], free galactosyl hydroxylysine [Gal-Hyl], calcium [Ca], inorganic phosphorus [P] and estradiol [E[2]] were measured in serum, whereas, deoxypyridinoline [Dpd] and creatinine levels were measured in urine. Simultaneously both osteopenic and osteoporotic groups showed significant decreases in BMD when compared to the controls. Osteocalcin, ALP and Gal-Hyl showed significant increase [p<0.0001] among the osteopenic and osteoporotic groups versus the control group. Significant decrease in E[2] levels were obvious among the osteopenic [p<0.0001] and osteoporotic [p<0.0001] women when judged against the controls. Urinary Dpd was significantly increased in the osteopenic and osteoporotic groups [p<0.001]. In osteoporotic group, significant negative correlations were observed between OC and BMD. Positive correlations were detected among the osteoporotic group between OC and ALP and between OC and Gal-Hyl. High significant negative correlations were confirmed between E[2] and OC among both the osteopenic and the osteoporotic groups. Also, a significant negative correlation was established between E[2] and Dpd in the osteoporotic group. In comparing between osteopenic and osteoporotic groups, significant decrease was recognized in BMD and significant increase was predicted regarding ALP, [p<0.05], Gal-Hyl [p<0.0001] and Dpd [p< 0.001]. Urinary Dpd may be a simple indicator for osteoporosis in postmenopausal women; however, screening should include the measurement of serum estradiol, galactosyl hydroxylysine, alkaline phosphatase and Osteocalcin to increase the sensitivity and specificity of primary screening to identify the groups at higher risk of osteoporosis which is the keystone in prevention of disabling fragility fractures