QUEEN’S UNIVERSITY BELFAST STUDENT ...

QUEEN’S UNIVERSITY BELFAST
STUDENT SELECTED COMPONENT
YEAR 2 : SPRING SEMESTER 2009
OSTEOPOROSIS
Silent Epidemic of the 21st Century
ARE PROTON PUMP INHIBITORS INCREASING THE RISK OF OSTEOPOROSIS-RELATED FRACTURES?
NAME : MAAMOR, EMMA YUHANIS
STUDENT NUMBER : 17172071
CO-ORDINATOR : DR. GRANT JORDAN
NUMBER OF WORDS : 2436 WORDS

ABSTRACT
Osteoporosis which is the result of the upset of bone maintenance is currently affecting over 200 million people globally. This makes it to be listed as one of the most serious global disease that needs to be tackled by WHO. The presence of underlying osteoporosis is responsible for the development of 56 million fractures including hip, humerus and spine which contribute to numbers of devastating consequences. To make it worse, the growing number of osteoporotic fractures and their associated morbidity are leaving a medical costs of $19 billion each year in the US and £726 million each year in the UK only. Recent studies are surprisingly claimed an unexpected finding that the use of proton pump inhibitor also contribute to the increasing risk of having osteoporosis. Three major studies with large number of population sample found a significant association between PPI and osteoporosis while one study did not prove the statement. They also suggest the pharmacodynamic of PPI can interfere with the calcium absorption and bone resorption process. However, further experimental studies are required to confirm these theories and also the clinical importance of the finding.

INTRODUCTION
Osteoporosis is estimated to affect over 200 million people worldwide in which United States (US) accounts for the greatest number of osteoporotic cases affecting 44 million people.1,2 These prevalence rates have become more significant for the past decades and this disease is now considered as one of the 10 most serious global health issues by World Health Organisation (WHO).3 Osteoporotic is well-known with its silence-attack-mechanism which causes the bone to become weaken and fragile. Most of the patients would not know they have osteoporosis until they have a fracture or have a bone mineral density (BMD) test with T-score less than -2.5.4
Classification of T scores according to WHO criteria5



T-score Interpretation
> -1 Normal
-2.5 < T < -1 Osteopenia
< -2.5 Osteoporosis



Osteoporosis results from the failure of bone mass maintenance process called bone remodelling which involves the replacement of old bone tissue (bone resorption) with new one (bone formation).6 It is mainly occurs in the adult skeleton and physiologically, the rate of bone resorption must balance out to the rate of bone formation. Interestingly, this equilibrium is determined by the activities of two tiny, yet vital cells of bone, osteoclasts and osteoblasts respectively. ...