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Xiong C, Zhao R, Xu J, Liang H, Zhang J, Huang Y, Luo X. Is Helicobacter pylori infection associated with osteoporosis? a systematic review and meta-analysis. J Bone Miner Metab 2023; 41:74-87. [PMID: 36348162 DOI: 10.1007/s00774-022-01379-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Accepted: 10/12/2022] [Indexed: 11/09/2022]
Abstract
INTRODUCTION This study used systematic review and meta-analysis to evaluate the association between Helicobacter pylori infection and osteoporosis. MATERIALS AND METHODS PubMed, Ovid and Web of Science were searched to include observational studies published in English comparing bone mineral density changes between Helicobacter pylori-positive and -negative participants. The quality of the included literature was assessed using the Newcastle-Ottawa Quality Assessment Scale (NOS). R software was used for meta-analysis, and odds ratio (OR) and 95% confidence interval (CI) were calculated to evaluate the relationship between Helicobacter pylori infection and osteoporosis. RESULTS Twenty-two studies involving 24,176 participants were included in the study. Our meta-analysis showed that Helicobacter pylori infection was significantly associated with the risk of osteoporosis (OR: 1.12, 95%CI: 1.03, 1.22). Participants infected with the CagA-positive Helicobacter pylori strain were more likely to develop osteoporosis (OR = 1.42, 95%CI: 1.09; 1.85). CONCLUSION Infection with Helicobacter pylori, particularly the CagA-positive strain, has been associated with an increased risk of osteoporosis. The bone health of Helicobacter pylori-positive patients deserves more attention.
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Affiliation(s)
- Chuang Xiong
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, No. 1, Youyi Road, Yuan Jiagang, Yuzhong District, Chongqing, 400016, People's Republic of China
| | - Runhan Zhao
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, No. 1, Youyi Road, Yuan Jiagang, Yuzhong District, Chongqing, 400016, People's Republic of China
| | - Jingtao Xu
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, No. 1, Youyi Road, Yuan Jiagang, Yuzhong District, Chongqing, 400016, People's Republic of China
| | - Hao Liang
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, No. 1, Youyi Road, Yuan Jiagang, Yuzhong District, Chongqing, 400016, People's Republic of China
| | - Jun Zhang
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, No. 1, Youyi Road, Yuan Jiagang, Yuzhong District, Chongqing, 400016, People's Republic of China
| | - Yanran Huang
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, No. 1, Youyi Road, Yuan Jiagang, Yuzhong District, Chongqing, 400016, People's Republic of China
| | - Xiaoji Luo
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, No. 1, Youyi Road, Yuan Jiagang, Yuzhong District, Chongqing, 400016, People's Republic of China.
- Orthopedic Laboratory of Chongqing Medical University, Chongqing, People's Republic of China.
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2
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Li J, Lu N, Lyu H, Lei G, Zeng C, Wei J, Wang Y, Xie D. Peptic Ulcer Disease and Risk of Hip Fracture: A General Population-based Cohort Study. J Clin Endocrinol Metab 2022; 107:e3738-e3746. [PMID: 35689555 DOI: 10.1210/clinem/dgac358] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Indexed: 12/20/2022]
Abstract
AIMS Previous studies reported proton pump inhibitor (PPI) use may increase the risk of fracture; however, the findings may be susceptible to indication bias because peptic ulcer disease (PUD), 1 major indication for PPIs, may affect skeletal health. Determining whether PUD would increase hip fracture risk may help identify high-risk populations and explore risk factors. METHODS We conducted a cohort study using data from The Health Improvement Network (THIN) in the United Kingdom. THIN contains patient information such as disease diagnosis and medicine prescriptions. Up to 5 non-PUD individuals (n = 138 265) were matched to each case of incident PUD (n = 27 653) by age, sex, and body mass index. We examined the association between PUD and hip fracture by a multivariable Cox proportional hazard model. We repeated the same analysis among individuals with incident PUD and gastroesophageal reflux disease (GERD) (n = 27 160), another disease with similar indication for PPIs, as a positive control exposure. RESULTS Over a mean of 5.6 years of follow-up, hip fracture occurred in 589 individuals with PUD and 2015 individuals without PUD (3.8 vs 2.6/1000 person-years), with a multivariable-adjusted hazard ratio (HR) being 1.44 (95% confidence interval [CI], 1.31-1.58). The association persisted among subgroups stratified by sex and age. In positive control exposure analysis, the hip fracture risk was also higher in PUD than GERD (3.8 vs 2.4/1000 person-years; multivariable-adjusted HR = 1.65; 95% CI, 1.45-1.7). CONCLUSIONS This general population-based cohort study suggests, after controlling for acid-lowering medication and other potential risk factors, PUD is independently associated with an increased risk of hip fracture.
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Affiliation(s)
- Jiatian Li
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, 410008, China
| | - Na Lu
- Arthritis Research Canada, Richmond, V5Y3P2, Canada
| | - Houchen Lyu
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, 410008, China
- National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing, 100853, China
- Department of Orthopedics, General Hospital of Chinese PLA, Beijing, 100853, China
| | - Guanghua Lei
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, 410008, China
- Hunan Key Laboratory of Joint Degeneration and Injury, Changsha, 410008, China
- Hunan Engineering Research Center for Osteoarthritis, Changsha, 410008, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, China
| | - Chao Zeng
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, 410008, China
- Hunan Key Laboratory of Joint Degeneration and Injury, Changsha, 410008, China
- Hunan Engineering Research Center for Osteoarthritis, Changsha, 410008, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, China
| | - Jie Wei
- Hunan Key Laboratory of Joint Degeneration and Injury, Changsha, 410008, China
- Hunan Engineering Research Center for Osteoarthritis, Changsha, 410008, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, China
- Health Management Center, Xiangya Hospital, Central South University, Changsha, 410008, China
| | - Yilun Wang
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, 410008, China
| | - Dongxing Xie
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, 410008, China
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3
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Bone Fragility in Gastrointestinal Disorders. Int J Mol Sci 2022; 23:ijms23052713. [PMID: 35269854 PMCID: PMC8910640 DOI: 10.3390/ijms23052713] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 02/24/2022] [Accepted: 02/25/2022] [Indexed: 02/04/2023] Open
Abstract
Osteoporosis is a common systemic disease of the skeleton, characterized by compromised bone mass and strength, consequently leading to an increased risk of fragility fractures. In women, the disease mainly occurs due to the menopausal fall in estrogen levels, leading to an imbalance between bone resorption and bone formation and, consequently, to bone loss and bone fragility. Moreover, osteoporosis may affect men and may occur as a sequela to different diseases or even to their treatments. Despite their wide prevalence in the general population, the skeletal implications of many gastrointestinal diseases have been poorly investigated and their potential contribution to bone fragility is often underestimated in clinical practice. However, proper functioning of the gastrointestinal system appears essential for the skeleton, allowing correct absorption of calcium, vitamins, or other nutrients relevant to bone, preserving the gastrointestinal barrier function, and maintaining an optimal endocrine-metabolic balance, so that it is very likely that most chronic diseases of the gastrointestinal tract, and even gastrointestinal dysbiosis, may have profound implications for bone health. In this manuscript, we provide an updated and critical revision of the role of major gastrointestinal disorders in the pathogenesis of osteoporosis and fragility fractures.
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4
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Kim TJ, Lee H, Min YW, Min BH, Lee JH, Rhee PL, Kim JJ. Cohort study of Helicobacter pylori infection and the risk of incident osteoporosis in women. J Gastroenterol Hepatol 2021; 36:657-663. [PMID: 32656854 DOI: 10.1111/jgh.15181] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 06/23/2020] [Accepted: 07/09/2020] [Indexed: 01/01/2023]
Abstract
BACKGROUND AND AIM Previous studies suggested an association between Helicobacter pylori infection and osteoporosis; however, large-scale longitudinal studies are lacking to elucidate this association. METHODS A cohort study of 10 482 women without osteoporosis at baseline who participated in a repeated health-screening examination including an H. pylori-specific immunoglobulin G antibody test was conducted to evaluate the association between H. pylori and osteoporosis development. Osteoporosis was diagnosed using dual-energy X-ray absorptiometry. RESULTS During the 77 515.3 person-years of follow-up, women with H. pylori infection had a higher rate of incident osteoporosis than those who were uninfected. In a multivariable model adjusted for age, body mass index (BMI), menopausal status, smoking status, regular exercise, comorbidities (including hypertension, diabetes mellitus, dyslipidemia, stroke, or ischemic heart disease), and concomitant medications, the hazard ratio (HR) for incident osteoporosis in women with H. pylori infection compared with that in women without infection was 1.23 (95% confidence interval [CI], 1.03-1.45). The association between H. pylori and osteopenia development was also evident. In the multivariable analysis, menopause (HR, 1.68; 95% CI, 1.31-2.16) and increasing age (HR, 1.07; 95% CI, 1.06-1.08) were identified as significant risk factors for osteoporosis, whereas higher BMI (HR, 0.84; 95% CI, 0.81-0.87) was a protective factor for the risk of osteoporosis. CONCLUSIONS In this cohort study, H. pylori infection was associated with an increased risk of osteoporosis, independent of risk factors and confounding factors.
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Affiliation(s)
- Tae Jun Kim
- Department of Digital Health, SAIHST, Sungkyunkwan University School of Medicine, Seoul, Korea.,Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyuk Lee
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yang Won Min
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Byung-Hoon Min
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jun Haeng Lee
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Poong-Lyul Rhee
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae J Kim
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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5
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Gennari L, Merlotti D, Figura N, Mingiano C, Franci MB, Lucani B, Picchioni T, Alessandri M, Campagna MS, Gonnelli S, Bianciardi S, Materozzi M, Caffarelli C, Gonnelli S, Nuti R. Infection by CagA-Positive Helicobacter pylori Strains and Bone Fragility: A Prospective Cohort Study. J Bone Miner Res 2021; 36:80-89. [PMID: 32790186 DOI: 10.1002/jbmr.4162] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Revised: 07/31/2020] [Accepted: 08/05/2020] [Indexed: 02/06/2023]
Abstract
Helicobacter pylori (HP) infection is a common and persistent disorder acting as a major cofactor for the development of upper gastrointestinal diseases and several extraintestinal disorders including osteoporosis. However, no prospective study assessed the effects of HP on bone health and fracture risk. We performed a HP screening in a population-based cohort of 1149 adults followed prospectively for up to 11 years. The presence of HP infection was assessed by serologic testing for serum antibodies to HP and the cytotoxin associated gene-A (CagA). The prevalence of HP infection did not differ among individuals with normal bone mineral density (BMD), osteoporosis, and osteopenia. However, HP infection by CagA-positive strains was significantly increased in osteoporotic (30%) and osteopenic (26%) patients respect to subjects with normal BMD (21%). Moreover, anti-CagA antibody levels were significantly and negatively associated with lumbar and femoral BMD. Consistent with these associations, patients affected by CagA-positive strains had a more than fivefold increased risk to sustain a clinical vertebral fracture (HR 5.27; 95% CI, 2.23-12.63; p < .0001) and a double risk to sustain a nonvertebral incident fracture (HR 2.09; 95% CI, 1.27-2.46; p < .005). Reduced estrogen and ghrelin levels, together with an impaired bone turnover balance after the meal were also observed in carriers of CagA-positive HP infection. HP infection by strains expressing CagA may be considered a risk factor for osteoporosis and fractures. Further studies are required to clarify in more detail the underlying pathogenetic mechanisms of this association. © 2020 American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- Luigi Gennari
- Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Daniela Merlotti
- Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Natale Figura
- Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Christian Mingiano
- Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Maria Beatrice Franci
- Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Barbara Lucani
- Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Tommaso Picchioni
- Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Mario Alessandri
- Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Maria Stella Campagna
- Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Sara Gonnelli
- Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Simone Bianciardi
- Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Maria Materozzi
- Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy.,Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Carla Caffarelli
- Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Stefano Gonnelli
- Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Ranuccio Nuti
- Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
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6
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Is there an association between peptic ulcer disease and osteoporosis: a systematic review and cumulative analysis. Eur J Gastroenterol Hepatol 2021; 33:9-16. [PMID: 33136725 DOI: 10.1097/meg.0000000000001981] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Mounting studies have emerged indicating that patients with peptic ulcer disease (PUD) are at a high risk of developing osteoporosis, but the evidence has not been previously synthesized. The present study aims to examine whether patients with PUD have a significantly higher prevalence of osteoporosis than the healthy normal subjects. METHODS Four electronic databases were systematically searched for eligible studies up to February 2020. The association between PUD and osteoporosis was evaluated by calculating the relative risk (RR) with a 95% confidence interval (CI). RESULTS Six observational studies were finally included, enrolling a total of 216 122 individuals. Synthetic results from the six included studies providing the number of cases for both sexes demonstrated that PUD was significantly associated with an increased risk of osteoporosis (95% CI, 1.37-1.89; P < 0.001). In line with this finding, the combined effect from the three studies independently reporting the male subjects also yielded to a positive relationship between PUD and osteoporosis (RR = 2.08; 95% CI,1.10-3.93; P = 0.023). However, when restricted to female participants, pooled results indicated that women patients with PUD would not suffer significantly more risk of osteoporosis than the general women population (RR = 1.36; 95% CI, 0.84-2.21, P = 0.212). CONCLUSIONS This is the first study for quantifying the positive association between PUD and the risk of osteoporosis by conducting a meta-analysis. In clinical practice, assessment of the bone mineral density and antiosteoporosis treatments are recommended for those potential patients with PUD.
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7
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Fisher L, Fisher A, Smith PN. Helicobacter pylori Related Diseases and Osteoporotic Fractures (Narrative Review). J Clin Med 2020; 9:E3253. [PMID: 33053671 PMCID: PMC7600664 DOI: 10.3390/jcm9103253] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 09/28/2020] [Accepted: 10/07/2020] [Indexed: 02/06/2023] Open
Abstract
Osteoporosis (OP) and osteoporotic fractures (OFs) are common multifactorial and heterogenic disorders of increasing incidence. Helicobacter pylori (H.p.) colonizes the stomach approximately in half of the world's population, causes gastroduodenal diseases and is prevalent in numerous extra-digestive diseases known to be associated with OP/OF. The studies regarding relationship between H.p. infection (HPI) and OP/OFs are inconsistent. The current review summarizes the relevant literature on the potential role of HPI in OP, falls and OFs and highlights the reasons for controversies in the publications. In the first section, after a brief overview of HPI biological features, we analyze the studies evaluating the association of HPI and bone status. The second part includes data on the prevalence of OP/OFs in HPI-induced gastroduodenal diseases (peptic ulcer, chronic/atrophic gastritis and cancer) and the effects of acid-suppressive drugs. In the next section, we discuss the possible contribution of HPI-associated extra-digestive diseases and medications to OP/OF, focusing on conditions affecting both bone homeostasis and predisposing to falls. In the last section, we describe clinical implications of accumulated data on HPI as a co-factor of OP/OF and present a feasible five-step algorithm for OP/OF risk assessment and management in regard to HPI, emphasizing the importance of an integrative (but differentiated) holistic approach. Increased awareness about the consequences of HPI linked to OP/OF can aid early detection and management. Further research on the HPI-OP/OF relationship is needed to close current knowledge gaps and improve clinical management of both OP/OF and HPI-related disorders.
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Affiliation(s)
- Leon Fisher
- Department of Gastroenterology, Frankston Hospital, Peninsula Health, Melbourne 3199, Australia
| | - Alexander Fisher
- Department of Geriatric Medicine, The Canberra Hospital, ACT Health, Canberra 2605, Australia;
- Department of Orthopedic Surgery, The Canberra Hospital, ACT Health, Canberra 2605, Australia;
- Australian National University Medical School, Canberra 2605, Australia
| | - Paul N Smith
- Department of Orthopedic Surgery, The Canberra Hospital, ACT Health, Canberra 2605, Australia;
- Australian National University Medical School, Canberra 2605, Australia
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8
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Chinda D, Shimoyama T, Sawada K, Iino C, Sakuraba H, Nakaji S, Fukuda S. Lifestyle Factors Rather Than Helicobacter pylori Infection or Estradiol Level are Associated With Osteopenia in Japanese Men. Am J Mens Health 2020; 13:1557988319848219. [PMID: 31043139 PMCID: PMC6498780 DOI: 10.1177/1557988319848219] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Although decreased calcium absorption, decreased bone formation, alcohol
drinking, and smoking have been considered as causes of osteopenia in men, the
cause is unknown in half of the cases. Many reports highlighted the association
between Helicobacter pylori infection and
osteoporosis, mainly in East Asia and Japan. To identify relevant factors of
osteoporosis in men, we examined estrogen and calcium intakes and other
lifestyle factors together with gastric mucosal atrophy caused by Helicobacter pylori infection. This study is a
cross-sectional study design of 268 healthy men who underwent general medical
examinations. Multivariate analysis was performed, with age, body mass index,
smoking habit, drinking habit, exercise habit, estradiol level, calcium intake,
and Helicobacter pylori infection and its
associated gastric mucosal atrophy as the independent variables and the presence
of osteopenia as the dependent variable. The adjusted odds ratio was 0.74 (95%
Confidence Interval [0.29, 1.90], p = .531) and
1.31 (95% Confidence Interval [0.54, 3.21], p =
.552), when Helicobacter pylori infection was
positive without and with gastric mucosal atrophy, respectively. Helicobacter pylori infection and gastric mucosal
atrophy were not significant factors. Low body mass index, smoking habit, and
low calcium intake were significantly associated with decreased bone density. In
conclusion, Helicobacter pylori infection was not
a significant risk, whereas low body mass index, current smoking, and lower
calcium intake had a significant influence on the development of osteopenia in
men.
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Affiliation(s)
- Daisuke Chinda
- 1 Department of Gastroenterology and Hematology, Hirosaki University Graduate School of Medicine, Japan.,2 Department of Community Medicine, Hirosaki University Graduate School of Medicine, Japan
| | - Tadashi Shimoyama
- 1 Department of Gastroenterology and Hematology, Hirosaki University Graduate School of Medicine, Japan.,3 Aomori General Health Examination Center, Japan
| | - Kaori Sawada
- 4 Department of Social Medicine, Hirosaki University Graduate School of Medicine, Japan
| | - Chikara Iino
- 1 Department of Gastroenterology and Hematology, Hirosaki University Graduate School of Medicine, Japan
| | - Hirotake Sakuraba
- 1 Department of Gastroenterology and Hematology, Hirosaki University Graduate School of Medicine, Japan
| | - Shigeyuki Nakaji
- 4 Department of Social Medicine, Hirosaki University Graduate School of Medicine, Japan
| | - Shinsaku Fukuda
- 1 Department of Gastroenterology and Hematology, Hirosaki University Graduate School of Medicine, Japan
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9
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Choi HG, Rhim CC, Yoon JY, Park BJ, Min CY, Lee SW. Increased risk of osteoporosis in patients with peptic ulcer: a follow-up study using a national sample cohort. Arch Osteoporos 2019; 14:105. [PMID: 31659478 DOI: 10.1007/s11657-019-0659-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 10/02/2019] [Indexed: 02/03/2023]
Abstract
UNLABELLED We performed a nationwide, population-based cohort study to investigate the risk of osteoporosis in patients with peptic ulcer disease in South Korea and concluded that peptic ulcer disease is associated with an increased risk of osteoporosis. PURPOSE This study aimed to evaluate the association between peptic ulcer disease (PUD) and the occurrence of osteoporosis using a national sample cohort from South Korea. METHODS Using the national cohort study from the Korean National Health Insurance Service, we extracted data for patients with PUD (n = 50,002) and for 1:1 matched control participants (n = 50,002); we then analyzed the occurrence of osteoporosis from 2002 to 2013. The patients were matched according to age, sex, income, region of residence, and past medical history. A stratified Cox proportional hazards model was used to analyze the hazard ratios (HRs) and the 95% confidence intervals (CIs). Subgroup analyses were performed based on age and sex. RESULTS The adjusted HR for osteoporosis was 1.36 (95% CI = 1.33-1.40, P < 0.001) in the PUD group. In the subgroup analysis based on age and sex, the respective adjusted HRs of PUD for osteoporosis were 1.33 (95% CI = 1.21-1.47) in the < 65-year-old group of men and 1.42 (95% CI = 1.30-1.56) in the ≥ 65-year-old group of men (each P < 0.001). The respective adjusted HRs of PUD for osteoporosis were 1.34 (95% CI = 1.29-1.39) in the < 65-year-old group of women and 1.38 (95% CI = 1.33-1.47) in the ≥ 65-year-old group of women (each P < 0.001). CONCLUSION In the current nationwide cohort study, we found that PUD is associated with an increased risk of osteoporosis regardless of sex.
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Affiliation(s)
- Hyo Geun Choi
- Department of Otorhinolaryngology-Head & Neck Surgery, Hallym University College of Medicine, Anyang, Republic of Korea.,Hallym Data Science Laboratory, Hallym University College of Medicine, Anyang, Republic of Korea
| | - Chae Chun Rhim
- Department of Obstetrics and Gynecology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, 22, Gwanpyeong-ro 170beon-gil, Dongan-gu, Anyang-si, Gyeonggi-do, 14068, Republic of Korea
| | - Ji Young Yoon
- Department of Obstetrics and Gynecology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, 22, Gwanpyeong-ro 170beon-gil, Dongan-gu, Anyang-si, Gyeonggi-do, 14068, Republic of Korea
| | - Bum Jung Park
- Department of Otorhinolaryngology-Head & Neck Surgery, Hallym University College of Medicine, Anyang, Republic of Korea
| | - Chan Yang Min
- Hallym Data Science Laboratory, Hallym University College of Medicine, Anyang, Republic of Korea
| | - Suk Woo Lee
- Department of Obstetrics and Gynecology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, 22, Gwanpyeong-ro 170beon-gil, Dongan-gu, Anyang-si, Gyeonggi-do, 14068, Republic of Korea.
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10
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Papamichael K, Papaioannou G, Cheifetz MA, Cheifetz AS. Bone of Contention: Helicobacter pylori and Osteoporosis-Is There an Association? Dig Dis Sci 2019; 64:2736-2739. [PMID: 31407131 DOI: 10.1007/s10620-019-05775-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 08/02/2019] [Indexed: 12/12/2022]
Abstract
Helicobacter pylori (H. pylori) infection is a common disease that can cause chronic gastritis, peptic ulcers, and gastric cancer. Nevertheless, due to its ability to elicit a systemic inflammatory response, it has also been related to several extra-gastric manifestations including endocrine disorders, such as autoimmune thyroid diseases, diabetes mellitus, dyslipidemia, and obesity. H. pylori infection has also been linked to osteoporosis, although currently available data are equivocal. This brief review will focus on the possible association between H. pylori infection and osteoporosis, a silent disease characterized by decreased bone mass that can increase the occurrence of fractures, disability, and mortality.
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Affiliation(s)
- Konstantinos Papamichael
- Division of Gastroenterology and Hepatology, Center for Inflammatory Bowel Disease, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave., Boston, MA, 02215, USA.
| | - Garyfallia Papaioannou
- North Florida Regional Medical Center, Internal Medicine Residency Program, College of Medicine, University of Central Florida, Gainesville, FL, USA
| | - Marcy A Cheifetz
- Department of Endocrinology, Harvard Vanguard Medical Associates/Atrius Health, Chestnut Hill, MA, USA
| | - Adam S Cheifetz
- Division of Gastroenterology and Hepatology, Center for Inflammatory Bowel Disease, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave., Boston, MA, 02215, USA
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11
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Yoon PH, An SJ, Jeong SH, Yang YJ, Hong YP. Association between Peptic Ulcer Disease and Osteoporosis: The Population-Based Longitudinal Cohort Study in Korea. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E2777. [PMID: 31382574 PMCID: PMC6696469 DOI: 10.3390/ijerph16152777] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Revised: 07/31/2019] [Accepted: 08/01/2019] [Indexed: 01/26/2023]
Abstract
OBJECTIVES The association between peptic ulcer disease (PUD) and osteoporosis remains unclear. We investigated the association between PUD and osteoporosis by classifying individuals based on gender in a prospective study on 10,030 adults in Korea at a 12-year follow-up examination. DESIGN AND SETTING The baseline survey of the Ansung-Ansan cohort studies was conducted from May 2001 to February 2003, and 10,030 participants (5018 from the Ansung study and 5012 from the Ansan study) completed the examination. PRIMARY OUTCOME MEASURES The risk of developing osteoporosis was higher in both men and women in the PUD group than in the control group. RESULTS At the 12-year follow-up, osteoporosis had developed in 11.1% (21/189) and 29.9% (56/187) of men and women in the PUD group, respectively. Meanwhile, in the control group, 4.8% (70/1464) and 16.5% (271/1639) of men and women, respectively, were presented with osteoporosis. The incidence rates per 1000 person-years were 20.5% and 68.5% in men and women in the PUD group and 11.2% and 42.3% of men and women in the control group, respectively. The risk of developing osteoporosis was higher in both men and women in the PUD group than in the control group (men: hazard ratio [HR] = 1.72, 95% confidence interval [CI] = 1.02-2.92; women: HR = 1.62, 95% CI = 1.20-2.18). CONCLUSION The risk of developing osteoporosis was significantly higher in both men and women in the PUD group than in the control group.
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Affiliation(s)
- Phill Hoon Yoon
- Division of Gastroenterology, Department of Internal Medicine, Catholic Kwandong University International St. Mary's Hospital, Incheon 22711, Korea
| | - Sang Joon An
- Department of Neurology, Catholic Kwandong University International St. Mary's Hospital, Incheon 22711, Korea
| | - Seok-Hoo Jeong
- Division of Gastroenterology, Department of Internal Medicine, Catholic Kwandong University International St. Mary's Hospital, Incheon 22711, Korea.
| | - Yun-Jung Yang
- Institute of Biomedical Science, Catholic Kwandong University International St. Mary's Hospital, Incheon 22711, Korea.
| | - Yeon-Pyo Hong
- Department of Preventive Medicine, College of Medicine, Chung-Ang University, Seoul 06974, Korea
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Wang T, Li X, Zhang Q, Ge B, Zhang J, Yu L, Cai T, Zhang Y, Xiong H. Relationship between Helicobacter pylori infection and osteoporosis: a systematic review and meta-analysis. BMJ Open 2019; 9:e027356. [PMID: 31248924 PMCID: PMC6597651 DOI: 10.1136/bmjopen-2018-027356] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES Many studies have explored the association between Helicobacter pylori infection and osteoporosis. However, the results remain controversial. Therefore, we performed this systematic review and meta-analysis to evaluate the association between H. pylori infection and osteoporosis. DESIGN Systematic review and meta-analysis of case-control studies. DATA SOURCES Databases, including PubMed, Embase, Web of Science and Chinese Biomedical Literature Database, were screened from inception to 30 April 2018. ELIGIBILITY CRITERIA Case-control studies aimed at assessing the association between H. pylori infection and osteoporosis. DATA EXTRACTION AND ANALYSIS Study characteristics and study quality sections were reviewed. Studies were selected, and data were extracted by two reviewers. Pooled ORs and 95% CIs were calculated using random effects model if heterogeneity existed; otherwise, fixed effects model was used. Subgroup analyses were performed to explore the source of heterogeneity. Publication bias and sensitivity analyses were also tested. RESULTS A total of 21 studies with 9655 participants were included in our analyses. Taking together, we found that H. pylori infection was associated with increased odds of osteoporosis (OR (95% CI): 1.39 (1.13 to 1.71)); there was no significant difference between osteoporosis and osteopaenia; the association between osteoporosis and H. pylori infection was relatively higher in men than women but did not reach significant level. However, the decrease of bone mineral density in H. pylori-positive patients was not significant when compared with H. pylori negative controls, which may due to the sample size. CONCLUSIONS Our meta-analysis suggests an association between osteoporosis and H. pylori infection. The clinicians should pay more attention to the patients infected with H. pylori. Further studies were still needed to exploring the confounding factors among studies and to elucidate the underlying biological mechanisms.
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Affiliation(s)
- Taiwu Wang
- Department of Epidemiology, Third Military Medical University, Chongqing, China
- Center for Disease Control and Prevention of Eastern Theater Command, Nanjing, China
| | - Xiang Li
- School of Pharmacy, The Southwest Medical University, Luzhou, China
| | - Qi Zhang
- Center for Disease Control and Prevention of Eastern Theater Command, Nanjing, China
| | - Bingjie Ge
- 95810 Unit, The Chinese People’s Liberation Army, Beijing, China
| | - Jinhai Zhang
- Center for Disease Control and Prevention of Eastern Theater Command, Nanjing, China
| | - Lei Yu
- Department of Epidemiology, Third Military Medical University, Chongqing, China
| | - Tongjian Cai
- Department of Epidemiology, Third Military Medical University, Chongqing, China
| | - Yao Zhang
- Department of Epidemiology, Third Military Medical University, Chongqing, China
| | - Hongyan Xiong
- Department of Epidemiology, Third Military Medical University, Chongqing, China
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Chinda D, Shimoyama T, Iino C, Matsuzaka M, Nakaji S, Fukuda S. Decrease of Estradiol and Several Lifestyle Factors, but Not Helicobacter pylori Infection, Are Significant Risks for Osteopenia in Japanese Females. Digestion 2018; 96:103-109. [PMID: 28787719 DOI: 10.1159/000479317] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 07/10/2017] [Indexed: 02/04/2023]
Abstract
BACKGROUND The primary cause of osteoporosis in women is increased bone resorption and decreased bone density associated with reduced estrogen secretion. Several studies have demonstrated a relationship between Helicobacter pylori infection and osteoporosis regardless of estrogen levels. This study examined the relationship between H. pylori infection and osteopenia together with estrogen levels, calcium intake, and several lifestyle factors. METHODS This study included 473 healthy women who underwent a general health examination. Multivariate analysis was performed, with age, body mass index (BMI), smoking habit, drinking habit, exercise habit, schooling duration, estradiol levels, birth history, calcium intake, schooling duration, smoking habit, drinking habit, exercise habit, and H. pylori infection as independent variables and the presence of osteopenia as a dependent variable. RESULTS The adjusted OR for osteopenia with H. pylori infection was 0.95 (95% CI 0.55-1.63, p = 0.84). In contrast, osteopenia was significantly associated with age, low BMI, lesser schooling period, low estradiol levels, and low calcium intake. CONCLUSIONS H. pylori infection was not a significant risk for osteopenia by the multivariate analysis, which included the primary confounding factors. Significant factors, such as estradiol and calcium intake, should be assessed together to study the association of H. pylori infection and osteopenia.
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Affiliation(s)
- Daisuke Chinda
- Department of Gastroenterology and Hematology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
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Correlation between Helicobacter pylori Infection and Metabolic Abnormality in General Population: A Cross-Sectional Study. Gastroenterol Res Pract 2018; 2018:7410801. [PMID: 29743888 PMCID: PMC5883933 DOI: 10.1155/2018/7410801] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2017] [Revised: 02/01/2018] [Accepted: 02/07/2018] [Indexed: 12/13/2022] Open
Abstract
Background Previous studies have suggested a link between Helicobacter pylori (H. pylori) and metabolic abnormality. This study aimed at investigating the correlation between H. pylori infection and metabolic abnormality in a general population. Methods All enrolled participants underwent a carbon-13 urea breath test (13C-UBT). For each individual, the following data were collected: age, gender, alanine transaminase (ALT), total protein, albumin, cholesterol, triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), urea nitrogen, creatinine, uric acid, fasting plasma glucose, postprandial blood sugar, nonalcoholic fatty liver disease (NAFLD), and bone mineral density (BMD). Results The study included 1867 (393 females and 1474 males, aged 54.0 ± 9.6 years) people that took a physical examination. There was no significant difference in gender and age between the study participants with and without H. pylori infection. The statistical data are as follows: albumin: P = 0.045, uric acid: P = 0.025, fasting glucose: P = 0.043, and postprandial blood glucose: P = 0.035. In terms of the patients with NAFLD, there were significant differences in ALT and HDL-C between the study participants with and without H. pylori infection. TG (P = 0.048), HDL-C (P = 0.011), and fasting blood glucose (P = 0.018) were significantly different in both groups among individuals who got osteopenia. Conclusion H. pylori infection may be an important factor affecting metabolic abnormality and osteoporosis.
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Bernardini G, Figura N, Ponzetto A, Marzocchi B, Santucci A. Application of proteomics to the study of Helicobacter pylori and implications for the clinic. Expert Rev Proteomics 2017; 14:477-490. [PMID: 28513226 DOI: 10.1080/14789450.2017.1331739] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Helicobacter pylori (H. pylori) is a gram-negative bacterium that colonizes the gastric epithelium and mucous layer of more than half the world's population. H. pylori is a primary human pathogen, responsible for the development of chronic gastritis, peptic ulceration and gastric cancer. Proteomics is impacting several aspects of medical research: understanding the molecular basis of infection and disease manifestation, identification of therapeutic targets and discovery of clinically relevant biomarkers. Areas covered: The main aim of the present review is to provide a comprehensive overview of the contribution of proteomics to the study of H. pylori infection pathophysiology. In particular, we focused on the role of the bacterium and its most important virulence factor, CagA, in the progression of gastric cells transformation and cancer progression. We also discussed the proteomic approaches aimed at the investigation of the host response to bacterial infection. Expert commentary: In the field of proteomics of H. pylori, comprehensive analysis of clinically relevant proteins (functional proteomics) rather than entire proteomes will result in important medical outcomes. Finally, we provided an outlook on the potential development of proteomics in H. pylori research.
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Affiliation(s)
- Giulia Bernardini
- a Dipartimento di Biotecnologie , Chimica e Farmacia, Università degli Studi di Siena , Siena , Italy
| | - Natale Figura
- a Dipartimento di Biotecnologie , Chimica e Farmacia, Università degli Studi di Siena , Siena , Italy
| | - Antonio Ponzetto
- b Dipartimento di Scienze Mediche , Università degli Studi di Torino , Torino , Italy
| | - Barbara Marzocchi
- a Dipartimento di Biotecnologie , Chimica e Farmacia, Università degli Studi di Siena , Siena , Italy
| | - Annalisa Santucci
- a Dipartimento di Biotecnologie , Chimica e Farmacia, Università degli Studi di Siena , Siena , Italy
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Chen LW, Chen FP, Hsieh CW, Kuo SF, Chien RN. Analysis of the associations among Helicobacter pylori infection, adiponectin, leptin, and 10-year fracture risk using the fracture risk assessment tool: A cross-sectional community-based study. PLoS One 2017; 12:e0175365. [PMID: 28388631 PMCID: PMC5384782 DOI: 10.1371/journal.pone.0175365] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Accepted: 03/26/2017] [Indexed: 01/28/2023] Open
Abstract
Helicobacter pylori (H. pylori) infection may induce inflammatory cytokines or adipokines that influence bone turnover and bone fracture risk. This study aimed to evaluate the association among H. pylori infection, adipokines, and 10-year fracture risk using the Fracture Risk Assessment Tool scale. From August 2013 to February 2016, a community-based cohort was surveyed by Keelung Chang-Gung Memorial Hospital. Subjects were included if they were older than 40 years and not pregnant. All participants underwent a standardized questionnaire survey, physical examination, urea breath test, and blood tests. A total of 2,689 participants (1,792 women) were included in this cross-sectional study. In both sexes, participants with a high fracture risk were older and had higher adiponectin values than participants without a high fracture risk (mean age, female: 72.9 ± 5.6 vs. 55.8 ± 7.3 years, P < 0.0001; male: 78.9 ± 4.7 vs. 58.1 ± 8.9 years, P < 0.001) (adiponectin, female: 10.8 ± 6.3 vs. 8.7 ± 5.2 ng/ml, P < 0.001; male: 9.7 ± 6.1 vs. 5.5 ± 3.8 ng/ml, P < 0.001). Adiponectin was correlated with high fracture risk in both sexes, but H. pylori infection and leptin was not. In logistic regression analysis, adiponectin could not predict high fracture risk when adjusting the factor of body mass index (BMI) in men group. In conclusion, H. pylori infection and leptin could not predict 10-year fracture risk in either sex. Adiponectin was correlated with bone fracture risk in both sexes and the correlation might be from the influence of BMI.
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Affiliation(s)
- Li-Wei Chen
- Department of Gastroenterology and Hepatology, Chang-Gung Memorial Hospital and University at Keelung, Keelung, Taiwan
- Community Medicine Research Center, Chang-Gung Memorial Hospital and University at Keelung, Keelung, Taiwan
| | - Fang-Ping Chen
- Department of Obstetrics and Gynecology, Chang-Gung Memorial Hospital at Keelung, Keelung, Taiwan
| | - Chia-Wen Hsieh
- Community Medicine Research Center, Chang-Gung Memorial Hospital and University at Keelung, Keelung, Taiwan
| | - Sheng-Fong Kuo
- Community Medicine Research Center, Chang-Gung Memorial Hospital and University at Keelung, Keelung, Taiwan
- Metabolism and Endocrinology, Chang-Gung Memorial Hospital and University at Keelung, Keelung, Taiwan
| | - Rong-Nan Chien
- Department of Gastroenterology and Hepatology, Chang-Gung Memorial Hospital and University at Keelung, Keelung, Taiwan
- Community Medicine Research Center, Chang-Gung Memorial Hospital and University at Keelung, Keelung, Taiwan
- * E-mail:
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17
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Kalantarhormozi MR, Assadi M, Vahdat K, Asadipooya K, Ostovar A, Raissi K, Darabi H, Farrokhi S, Dobaradaran S, Farrokhnia M, Nabipour I. Chlamydia pneumoniae and Helicobacter pylori IgG seropositivities are not predictors of osteoporosis-associated bone loss: a prospective cohort study. J Bone Miner Metab 2016; 34:422-8. [PMID: 26056026 DOI: 10.1007/s00774-015-0688-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Accepted: 05/09/2015] [Indexed: 01/10/2023]
Abstract
The potential link between infection with Chlamydia pneumoniae or Helicobacter pylori and osteoporosis has not been investigated in population-based longitudinal studies. A total of 250 healthy postmenopausal women who participated in a prospective cohort study were evaluated for IgG antibodies directed against C. pneumoniae and H. p ylori, osteoprotegerin (OPG), the receptor activator of nuclear factor kappa B ligand (RANKL), CrossLaps, and osteocalcin. Bone mineral density (BMD) was measured at the femoral neck and lumbar spine at baseline and at follow-up 5.8 years later. There were no significant differences in age-adjusted bone turnover markers, OPG, RANKL, the RANKL/OPG ratio, and BMD between the C. p neumoniae and H. p ylori IgG seropositive and seronegative subjects (P > 0.05). Neither C. p neumoniae nor H. p ylori IgG seropositivity was associated with age-and body mass index-adjusted BMD at the femoral neck and lumbar spine or bone loss at the 5.8-year follow-up. In logistic regression analysis, neither C. p neumoniae nor H. p ylori IgG seropositivities predicted incident lumbar or spine osteoporosis 5.8 years later. In conclusion, neither C. p neumoniae nor H. p ylori IgG seropositivity was associated with bone turnover markers, the RANKL/OPG ratio, BMD, or bone loss in postmenopausal women. In addition, chronic infection with C. p neumoniae or H. p ylori did not predict incident osteoporosis among this group of women.
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Affiliation(s)
- Mohammad Reza Kalantarhormozi
- Department of Endocrine and Metabolic Diseases, The Persian Gulf Tropical Medicine Research Centre, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Majid Assadi
- The Persian Gulf Nuclear Medicine Research Centre, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Katayoun Vahdat
- Department of Infectious Diseases, The Persian Gulf Tropical Medicine Research Centre, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Kamyar Asadipooya
- Division of Endocrinology and Metabolism, University of Kansas Medical Center, Kansas City, KS, USA
| | - Afshin Ostovar
- Department of Infectious Diseases, The Persian Gulf Tropical Medicine Research Centre, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Katayoun Raissi
- Department of Endocrine and Metabolic Diseases, The Persian Gulf Tropical Medicine Research Centre, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Hossein Darabi
- Department of Infectious Diseases, The Persian Gulf Tropical Medicine Research Centre, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Shokrollah Farrokhi
- Department of Infectious Diseases, The Persian Gulf Tropical Medicine Research Centre, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Sina Dobaradaran
- Department of Infectious Diseases, The Persian Gulf Tropical Medicine Research Centre, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Maryam Farrokhnia
- Department of Biochemistry, The Persian Gulf Marine Biotechnology Research Centre, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Iraj Nabipour
- Department of Biochemistry, The Persian Gulf Marine Biotechnology Research Centre, Bushehr University of Medical Sciences, Bushehr, Iran.
- The Persian Gulf Tropical Medicine Research Center, Boostan 19 Alley, Imam Khomeini St, 7514763448, Bushehr, Iran.
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He D, Yu W, Chen Z, Li L, Zhu K, Fan S. Pathogenesis of the intravertebral vacuum of Kümmell's disease. Exp Ther Med 2016; 12:879-882. [PMID: 27446290 PMCID: PMC4950591 DOI: 10.3892/etm.2016.3369] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Accepted: 05/19/2016] [Indexed: 12/20/2022] Open
Abstract
In this review, we explored the progress of the pathogenesis of Kümmell's disease intravertebral vacuum. Using different expressions of the same disease including 'Kümmell's disease', 'avascular necrosis after vertebral compression fracture (VCF)', 'post-traumatic vertebral osteonecrosis', 'vertebral pseudarthrosis', 'intravertebral vacuum (cleft or gas)', 'delayed vertebral collapse', 'VCF nonunion', and by conducting a search of the PubMed database, we analyzed the results to examine the pathogenesis of the intravertebral vacuum of Kümmell's disease after referring to pertinent literature on intravertebral vacuum of ischemic necrosis after VCF, and exploring the progress of pathogenesis of this disease. A number of discrepancies were identified within the pathogenesis of the intravertebral vacuum after VCF. There were statements such as avascular necrosis of the vertebral body, bone biomechanics, gas forming and other types of claims, all of which obtained clinical and biomechanical supporting evidence. Collectively, most of the researchers believe that Kümmell vertebral fracture syndrome was the comprehensive effect of multiple factors including osteoporosis, avascular necrosis of the vertebral body, and biomechanical changes following fracture. However, there are a number of discrepancies to be resolved and future studies are therefore needed.
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Affiliation(s)
- Dengwei He
- Department of Orthopaedics, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310016, P.R. China; Department of Orthopedics, Lishui Central Hospital, Wenzhou Medical University, Lishui, Zhejiang 323000, P.R. China
| | - Weiyang Yu
- Department of Orthopedics, Lishui Central Hospital, Wenzhou Medical University, Lishui, Zhejiang 323000, P.R. China
| | - Zhenzhong Chen
- Department of Orthopedics, Lishui Central Hospital, Wenzhou Medical University, Lishui, Zhejiang 323000, P.R. China
| | - Liangchen Li
- Department of Orthopedics, Lishui Central Hospital, Wenzhou Medical University, Lishui, Zhejiang 323000, P.R. China
| | - Kejun Zhu
- Department of Orthopedics, Lishui Central Hospital, Wenzhou Medical University, Lishui, Zhejiang 323000, P.R. China
| | - Shunwu Fan
- Department of Orthopaedics, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310016, P.R. China
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Wu CH, Tung YC, Chai CY, Lu YY, Su YF, Tsai TH, Kuo KL, Lin CL. Increased Risk of Osteoporosis in Patients With Peptic Ulcer Disease: A Nationwide Population-Based Study. Medicine (Baltimore) 2016; 95:e3309. [PMID: 27100415 PMCID: PMC4845819 DOI: 10.1097/md.0000000000003309] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
To investigate osteoporosis risk in patients with peptic ulcer disease (PUD) using a nationwide population-based dataset. This Taiwan National Health Insurance Research Database (NHIRD) analysis included 27,132 patients aged 18 years and older who had been diagnosed with PUD (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM] codes 531-534) during 1996 to 2010. The control group consisted of 27,132 randomly selected (age- and gender)-matched patients without PUD. The association between PUD and the risk of developing osteoporosis was estimated using a Cox proportional hazard regression model. During the follow-up period, osteoporosis was diagnosed in 2538 (9.35 %) patients in the PUD group and in 2259 (8.33 %) participants in the non-PUD group. After adjusting for covariates, osteoporosis risk was 1.85 times greater in the PUD group compared to the non-PUD group (13.99 vs 5.80 per 1000 person-years, respectively). Osteoporosis developed 1 year after PUD diagnosis. The 1-year follow-up period exhibited the highest significance between the 2 groups (hazard ratio [HR] = 63.44, 95% confidence interval [CI] = 28.19-142.74, P < 0.001). Osteoporosis risk was significantly higher in PUD patients with proton-pump-inhibitors (PPIs) use (HR = 1.17, 95% CI = 1.03-1.34) compared to PUD patients without PPIs use. This study revealed a significant association between PUD and subsequent risk of osteoporosis. Therefore, PUD patients, especially those treated with PPIs, should be evaluated for subsequent risk of osteoporosis to minimize the occurrence of adverse events.
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Affiliation(s)
- Chieh-Hsin Wu
- From the Graduate Institute of Medicine (C-HW, C-YC, Y-YL, C-LL), Department of Public Health and Environmental Medicine (Y-CT), Department of Pathology (C-YC), Department of Neurosurgery, Faculty of Medicine, College of Medicine (C-LL), Department of Neurosurgery (C-HW, Y-FS, T-HT, K-LK, C-LL), Department of Pathology, Kaohsiung Medical University Hospital, Kaohsiung Medical University (C-YC), Institute of Biomedical Sciences, National Sun Yat-Sen University (C-YC), Department of Dermatology, Kaohsiung Veterans General Hospital (Y-YL), and Cosmetic Applications and Management Department, Yuh-Ing Junior College of Health Care & Management, Kaohsiung, Taiwan (Y-YL)
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20
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Chung YH, Gwak JS, Hong SW, Hyeon JH, Lee CM, Oh SW, Kwon H. Helicobacter pylori: A Possible Risk Factor for Bone Health. Korean J Fam Med 2015; 36:239-44. [PMID: 26435815 PMCID: PMC4591390 DOI: 10.4082/kjfm.2015.36.5.239] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Revised: 06/15/2015] [Accepted: 08/21/2015] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Helicobacter pylori (H. pylori) infection may cause systemic inflammation and increase the production of tumor necrosis factor-α, interleukin-1, and interleukin-6. Unfortunately, bone mineral density also may be affected by these cytokines. This study aimed to evaluate the association between bone mineral density and H. pylori infection. METHODS A cross-sectional study evaluated 1,126 men undergoing a comprehensive health screening in a private Korean screening center. Subjects' sera were tested for H. pylori antibodies (immunoglobulin G) using an enzyme-linked immunosorbent assay, and bone mineral densities (g/cm(2)) of the lumbar spine, femoral neck, and total femur were obtained using dual-energy X-ray absorptiometry. To evaluate the difference in bone mineral density according to H. pylori infection status, the adjusted mean bone mineral densities at each site were compared after adjusting for potential confounders, including age, sex, body mass index, smoking, alcohol consumption, and exercise. RESULTS H. pylori infection was associated with a significant decrease in mean lumbar bone mineral density (H. pylori-positive, 1.190 g/cm(2); H. pylori-negative, 1.219 g/cm(2); P=0.006), which was greatest among men who were ≥50 years old (H. pylori-positive, 1.193 g/cm(2); H. pylori-negative, 1.233 g/cm(2); P=0.006). However, no significant association was observed in the bone mineral densities of the total femur and femoral neck. CONCLUSION In men, H. pylori infection was negatively associated with lumbar bone mineral density. This association may be useful in the early detection, prevention, and management of male osteoporosis.
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Affiliation(s)
- Yun Hee Chung
- Department of Family Medicine, Seoul National University, Seoul, Korea
| | - Jong Seop Gwak
- Department of Family Medicine, Seoul National University, Seoul, Korea
| | - Sung Woo Hong
- Department of Family Medicine, Seoul National University, Seoul, Korea
| | - Jung Hyeon Hyeon
- Department of Family Medicine, Seoul National University, Seoul, Korea
| | - Cheol Min Lee
- Department of Family Medicine, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Korea
| | - Seung Won Oh
- Department of Family Medicine, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Korea
| | - Hyuktae Kwon
- Department of Family Medicine, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Korea
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Mizuno S, Matsui D, Watanabe I, Ozaki E, Kuriyama N, Watanabe Y. Serologically Determined Gastric Mucosal Condition Is a Predictive Factor for Osteoporosis in Japanese Men. Dig Dis Sci 2015; 60:2063-9. [PMID: 25663243 DOI: 10.1007/s10620-015-3576-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Accepted: 01/31/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND There are few reports about the influence of Helicobacter pylori infection and/or atrophic gastritis on bone conditions in Japan. AIMS To assess whether the combination of serologically determined Helicobacter pylori infection and atrophic gastritis is available as a biomarker for bone conditions. METHODS We studied 230 men in their 50s and 60s. Helicobacter pylori infection was determined using serum antibody to this bacterium. Atrophic gastritis was diagnosed on the basis of the serum pepsinogen I and II criteria. The characteristics of the participants' bone were measured at the radius using an ultrasonic bone densitometry system. The risks of low trabecular bone density, low elastic modulus of trabecular bone, and low cortical thickness among subjects who were positive for Helicobacter pylori infection and/or atrophic gastritis relative to those who were not were calculated. RESULTS Helicobacter pylori infection significantly increased the risk of low trabecular bone density (odds ratio 1.83, 95 % confidence interval 1.04-3.21, P = 0.03). Atrophic gastritis significantly increased the risk of low trabecular bone density (2.22, 1.17-4.22, 0.01). Compared with anti-Helicobacter pylori antibody (-) and atrophic gastritis (-) subjects, anti-Helicobacter pylori antibody (+) and atrophic gastritis (+) subjects were a significant high-risk group for low trabecular bone density (2.65, 1.27-5.55, 0.01). CONCLUSIONS A serological diagnosis of Helicobacter pylori infection and atrophic gastritis, which is utilized for risk assessment of gastric cancer, was suggested to be useful for risk assessment of osteoporosis.
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Affiliation(s)
- Shigeto Mizuno
- Department of Medical Pharmaceutics, Kobe Pharmaceutical University, 4-19-1 Motoyama-kita, Higashinada-ku, Kobe, 658-8558, Japan,
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22
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Asaoka D, Nagahara A, Shimada Y, Matsumoto K, Ueyama H, Matsumoto K, Nakagawa Y, Takeda T, Tanaka I, Sasaki H, Osada T, Hojo M, Watanabe S. Risk factors for osteoporosis in Japan: is it associated with Helicobacter pylori? Ther Clin Risk Manag 2015; 11:381-91. [PMID: 25834453 PMCID: PMC4358368 DOI: 10.2147/tcrm.s80647] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Background A number of diseases and drugs may influence bone mineral density; however, there are few reports concerning the relationship between lifestyle-related diseases and osteoporosis in Japan as determined by multivariate analysis. The aim of this study was to investigate the risk factors for osteoporosis and whether infection by or eradication of Helicobacter pylori is associated with osteoporosis. Methods Between February 2008 and November 2014, using a cross-sectional study design, we investigated patient profile (age, sex, BMI, alcohol, smoking), H. pylori infection status, comorbidities, internal medicine therapeutic agents (calcium channel blocker, HMG-CoA reductase inhibitors, proton pump inhibitor), serum parameters (Hb, calcium, γGTP), bone turn over markers (bone-specific alkaline phosphatase (BAP) and collagen type I cross-linked N telopeptide (NTX), findings on dual-energy x-ray absorptiometry (DEXA) and upper gastrointestinal endoscopy, and Frequency Scale for the Symptoms of GERD score in consecutive outpatients aged ≥50 years at our hospital. We divided the subjects into an osteoporosis group and a non-osteoporosis group and investigated risk factors for osteoporosis between the two groups by bivariate and multivariate analyses. Results Of the 255 eligible study subjects, 43 (16.9%) had osteoporosis. Bivariate analysis showed that advanced age, female sex, lower body mass index, lower cumulative alcohol intake, lower Brinkman index, H. pylori positivity, lower hemoglobin, bone-specific alkaline phosphatase, lower prevalence of hiatal hernia, and endoscopic gastric mucosal atrophy were related to osteoporosis. Multivariate analysis showed that advanced age (odds ratio [OR] 1.13, 95% confidence interval [CI] 1.07–1.19, P<0.001), female sex (OR 6.27, 95% CI 2.26–17.39, P<0.001), low BMI (OR 0.82, 95% CI 0.72–0.94, P=0.005), H. pylori positivity (OR 3.00, 95% CI 1.31–6.88, P=0.009), and BAP (OR 1.07, 95% CI 1.01–1.14, P=0.035) were related to osteoporosis. Conclusion Advanced age, low BMI, BAP, and H. pylori positivity were risk factors for osteoporosis; however, the success of H. pylori eradication was not a risk factor for osteoporosis in Japan.
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Affiliation(s)
- Daisuke Asaoka
- Department of Gastroenterology, University of Juntendo, School of Medicine, Tokyo, Japan
| | - Akihito Nagahara
- Department of Gastroenterology, University of Juntendo, School of Medicine, Tokyo, Japan
| | - Yuji Shimada
- Department of Gastroenterology, University of Juntendo, School of Medicine, Tokyo, Japan
| | - Kenshi Matsumoto
- Department of Gastroenterology, University of Juntendo, School of Medicine, Tokyo, Japan
| | - Hiroya Ueyama
- Department of Gastroenterology, University of Juntendo, School of Medicine, Tokyo, Japan
| | - Kohei Matsumoto
- Department of Gastroenterology, University of Juntendo, School of Medicine, Tokyo, Japan
| | - Yuta Nakagawa
- Department of Gastroenterology, University of Juntendo, School of Medicine, Tokyo, Japan
| | - Tsutomu Takeda
- Department of Gastroenterology, University of Juntendo, School of Medicine, Tokyo, Japan
| | - Ippei Tanaka
- Department of Gastroenterology, University of Juntendo, School of Medicine, Tokyo, Japan
| | - Hitoshi Sasaki
- Department of Gastroenterology, University of Juntendo, School of Medicine, Tokyo, Japan
| | - Taro Osada
- Department of Gastroenterology, University of Juntendo, School of Medicine, Tokyo, Japan
| | - Mariko Hojo
- Department of Gastroenterology, University of Juntendo, School of Medicine, Tokyo, Japan
| | - Sumio Watanabe
- Department of Gastroenterology, University of Juntendo, School of Medicine, Tokyo, Japan
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The Relationship between H. pylori Infection and Osteoporosis in Japan. Gastroenterol Res Pract 2014; 2014:340765. [PMID: 25024699 PMCID: PMC4082917 DOI: 10.1155/2014/340765] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Accepted: 05/26/2014] [Indexed: 12/30/2022] Open
Abstract
Background and Objective. H. pylori infection causes a chronic inflammation in the gastric mucosa. However, this local inflammation may result in extra-digestive conditions. Our aim is to investigate the relationship between H. pylori infection and osteoporosis in Japan. Methods. This cross-sectional study was conducted among outpatients at the Juntendo University Hospital between 2008 and 2014. Participants for patient profile, H. pylori infection status, comorbidity, internal medical therapies, lumbar dual-energy X-ray absorptiometry (DXA), and bone turnover marker were collected and upper gastrointestinal endoscopy for reflux esophagitis, hiatal hernia, peptic ulcer disease (PUD), and endoscopic gastric mucosal atrophy (EGA) was performed. The diagnosis of osteoporosis was performed in accordance with the Japanese criteria. We investigated risk factors of osteoporosis. Results. Of the eligible 200 study subjects, 41 cases were of osteoporosis. Bivariate analysis showed that age, being female, BMI, alcohol, smoking, H. pylori, bone-specific ALP, PUD, and EGA were related to osteoporosis. Multivariate analysis showed that age (OR 1.13; 95%CI 1.07-1.20), being female (OR 4.77; 95%CI 1.78-12.77), BMI (OR 0.79; 95%CI 0.68-0.92), H. pylori (OR 5.33; 95%CI 1.73-16.42), and PUD (OR 4.98; 95%CI 1.51-16.45) were related to osteoporosis. Conclusions. H. pylori infection may be a risk factor of osteoporosis in Japan.
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Ding J, Heller DA, Ahern FM, Brown TV. The relationship between proton pump inhibitor adherence and fracture risk in the elderly. Calcif Tissue Int 2014; 94:597-607. [PMID: 24706060 DOI: 10.1007/s00223-014-9855-6] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Accepted: 03/19/2014] [Indexed: 12/14/2022]
Abstract
Studies suggest that long-term use of proton pump inhibitors (PPIs) may be associated with an increased risk of fracture. However, the role of medication adherence in this association is not fully understood. A retrospective cohort study was conducted to examine the relationship between PPI use/adherence and fracture risk among elderly subjects by combining administrative pharmacy claims data, survey data, and Medicare data. The study cohort included 1,604 PPI users and 23,672 nonusers who were enrolled in Pennsylvania's Pharmaceutical Assistance Contract for the Elderly program. PPI adherence was measured by the proportion of days covered (PDC). Time-dependent Cox proportional hazards models were used to estimate adjusted hazard ratios (HRs) of PPI use/adherence for fracture risk while controlling for demographics, comorbidity, body mass index, smoking, and non-PPI medication use. The overall incidence of any fracture per 100 person-years was 8.7 for PPI users and 5.0 for nonusers. A gradient in fracture risk according to PPI adherence was observed. Relative to nonusers, fracture HRs associated with the highest (PDC ≥ 0.80), intermediate (PDC 0.40-0.79), and lowest (PDC <0.40) adherence levels were 1.46 (p < 0.0001), 1.30 (p = 0.02), and 0.95 (p = 0.75), respectively. In addition, the fracture risk of PPI use was significant for hip (HR = 1.32, p = 0.04) and vertebral (HR = 1.69, p = 0.0005) fractures, and risk was similar between major osteoporotic and other fractures. These results provide further evidence that PPI use may increase fracture risk in the elderly and highlight the need for clinicians to periodically reassess elderly patients' individualized needs for ongoing PPI therapy, while weighing potential risks and benefits.
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Affiliation(s)
- Jian Ding
- Magellan Health Services/PACE, 4000 Crums Mill Road, Suite 301, Harrisburg, PA, 17112, USA,
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25
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Association between Helicobacter pylori Infection and Risk of Osteoporosis in Elderly Taiwanese Women with Upper Gastrointestinal Diseases: A Retrospective Patient Record Review. Gastroenterol Res Pract 2014; 2014:814756. [PMID: 24959176 PMCID: PMC4053086 DOI: 10.1155/2014/814756] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Revised: 04/29/2014] [Accepted: 04/30/2014] [Indexed: 11/18/2022] Open
Abstract
Introduction. Helicobacter pylori (H. pylori) infection could lead to chronic local and systemic immune response. The resulting increase in proinflammatory cytokines could affect bone resorption and might increase the risk of osteoporosis. This study aimed to investigate the association between H. pylori infection and osteoporosis in elderly female patients with upper gastrointestinal diseases. Methods. A retrospective patient record review study was conducted in a regional teaching hospital in south Taiwan. Relevant information on female patients aged 65 and over who were diagnosed with diseases of esophagus, gastric ulcer, or duodenal ulcer during January 2008 to December 2010 were abstracted. Association between H. pylori infection and osteoporosis was evaluated using multivariate logistic regression analysis. Results. Of the 365 patients with a mean age of 77.3 years, 77 (21.1%) had H. pylori infection and 101 (27.7%) had been diagnosed with osteoporosis. Multivariate logistic regression analysis revealed that osteoporosis was significantly associated with H. pylori infection (adjusted odds ratio = 2.03, 95% confidence interval = 1.14-3.62) after adjusting for age group, body mass index group, and use of proton pump inhibitor. Conclusion. Osteoporosis was found to be associated with H. pylori infection in Taiwanese female patients with upper gastrointestinal diseases. Further studies with information on potential confounders are needed to confirm the association.
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Ueyama T, Yamamoto Y, Ueda K, Yajima A, Maeda Y, Yamashita Y, Ito T, Tsuruo Y, Ichinose M. Is gastrectomy-induced high turnover of bone with hyperosteoidosis and increase of mineralization a typical osteomalacia? PLoS One 2013; 8:e65685. [PMID: 23776526 PMCID: PMC3679169 DOI: 10.1371/journal.pone.0065685] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2012] [Accepted: 04/26/2013] [Indexed: 11/19/2022] Open
Abstract
Gastrectomy (GX) is thought to result in osteomalacia due to deficiencies in Vitamin D and Ca. Using a GX rat model, we showed that GX induced high turnover of bone with hyperosteoidosis, prominent increase of mineralization and increased mRNA expression of both osteoclast-derived tartrate-resistant acid phosphatase 5b and osteocalcin. The increased 1, 25(OH)2D3 level and unchanged PTH and calcitonin levels suggested that conventional bone and Ca metabolic pathways were not involved or changed in compensation. Thus, GX-induced bone pathology was different from a typical osteomalacia. Gene expression profiles through microarray analysis and data mining using Ingenuity Pathway Analysis indicated that 612 genes were up-regulated and 1,097 genes were down-regulated in the GX bone. These genes were related functionally to connective tissue development, skeletal and muscular system development and function, Ca signaling and the role of osteoblasts, osteoclasts and chondrocytes. Network analysis indicated 9 genes (Aldehyde dehydrogenase 1 family, member A1; Aquaporin 9; Interleukin 1 receptor accessory protein; Very low density lipoprotein receptor; Periostin, osteoblast specific factor; Aggrecan; Gremlin 1; Angiopoietin-like 4; Wingless-type MMTV integration site family, member 10B) were hubs connected with tissue development and immunological diseases. These results suggest that chronic systemic inflammation might underlie the GX-induced pathological changes in bone.
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Affiliation(s)
- Takashi Ueyama
- Department of Anatomy and Cell Biology, Wakayama Medical University Graduate School of Medicine, Wakayama, Japan.
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27
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Abrahamsen B, Rubin KH, Eiken PA, Eastell R. Characteristics of patients who suffer major osteoporotic fractures despite adhering to alendronate treatment: a National Prescription registry study. Osteoporos Int 2013; 24:321-8. [PMID: 23070480 DOI: 10.1007/s00198-012-2184-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2012] [Accepted: 10/01/2012] [Indexed: 01/26/2023]
Abstract
UNLABELLED Antiresorptive treatment reduces the risk of fractures, but most patients remain at elevated risk. We used health registers to identify predictors of new major osteoporotic fractures in patients adhering to alendronate. Risk factors showed a different pattern than in the general population and included dementia, ulcer disease, and Parkinson's disease. INTRODUCTION Antiresorptives reduce the excess risk of fractures in patients with osteoporosis, but most patients remain at elevated risk. In some countries, patients must sustain fractures while on bisphosphonate (BP) treatment to qualify for more expensive treatment. It is unclear if patients who fracture on BP can be viewed as a distinct subgroup. METHODS The National Prescription registry was used to identify 38,088 new alendronate users. The outcome was major osteoporotic fractures 6+ months after filling the first prescription in patients with a medication possession ratio > 80 %. RESULTS One thousand and seventy-two (5.5 %) patients sustained major osteoporotic fractures. The risk increased with age and was lower in men. The most important risk factor was the number of comedications (hazard ratio (HR) 1.04, 95 % CI 1.03-1.06, for each drug). Dementia (HR 1.81, 95 % CI 1.18-2.78), prior fracture (one: HR 1.17, 95 % CI 1.02-1.34; multiple: HR 1.34, 95 % CI 1.08-1.67), and ulcer disease (HR 1.45, 95 % CI 1.04-2.03) also increased the risk. Diabetes did not influence fracture risk, nor did rheumatic disorders. The risk was lower in glucocorticoid users (HR 0.78, 95 % CI 0.65-0.93). CONCLUSION Risk factors while adhering to BP show a somewhat different pattern than that of the general population and FRAX. Ulcer disease and dementia may impair the ability to use the medications correctly. Though this is an observational study and associations may not be causal, it may be prudent to include dementia, ulcer disease, and Parkinson's disease to capture the risk of fractures on treatment. Lower risk in patients treated with glucocorticoids and in men probably reflects a lower treatment threshold related to guidelines.
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Affiliation(s)
- B Abrahamsen
- Odense Patient data Exploratory Network (OPEN), Institute of Clinical Research, University of Southern Denmark, Odense, Denmark.
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28
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Merlotti D, Gennari L, Stolakis K, Nuti R. Aromatase activity and bone loss in men. J Osteoporos 2011; 2011:230671. [PMID: 21772971 PMCID: PMC3135090 DOI: 10.4061/2011/230671] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2011] [Accepted: 04/20/2011] [Indexed: 11/20/2022] Open
Abstract
Aromatase is a specific component of the cytochrome P450 enzyme system responsible for the transformation of androgen precursors into estrogens. This enzyme is encoded by the CYP19A1 gene located at chromosome 15q21.2, that is, expressed in ovary and testis, but also in many extraglandular sites such as the placenta, brain, adipose tissue, and bone. The activity of aromatase regulates the concentrations of estrogens with endocrine, paracrine, and autocrine effects on target issues including bone. Importantly, extraglandular aromatization of circulating androgen precursors is the major source of estrogen in men. Clinical and experimental evidences clearly indicate that aromatase activity and estrogen production are necessary for longitudinal bone growth, the attainment of peak bone mass, pubertal growth spurt, epiphyseal closure, and normal bone remodeling in young individuals. Moreover, with aging, individual differences in aromatase activity may significantly affect bone loss and fracture risk in men.
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Eom CS, Park SM, Myung SK, Yun JM, Ahn JS. Use of acid-suppressive drugs and risk of fracture: a meta-analysis of observational studies. Ann Fam Med 2011; 9:257-67. [PMID: 21555754 PMCID: PMC3090435 DOI: 10.1370/afm.1243] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
PURPOSE Previous studies have reported inconsistent findings regarding the association between the use of acid-suppressive drugs such as proton pump inhibitors (PPIs) and histamine 2 receptor antagonists (H(2)RAs) and fracture risk. We investigated this association using meta-analysis. METHODS We searched MEDLINE (PubMed), EMBASE, and the Cochrane Library from inception through December 2010 using common key words. We included case-control, nested case-control, and cohort studies. Two evaluators independently reviewed and selected articles. We determined pooled effect estimates by using random-effects meta-analysis, because of heterogeneity. RESULTS Of 1,809 articles meeting our initial inclusion criteria, 5 case-control studies, 3 nested case-control studies, and 3 cohort studies were included in the final analyses. The pooled odds ratio (OR) for fracture was 1.29 (95% confidence interval [CI], 1.18-1.41) with use of PPIs and 1.10 (95% CI, 0.99-1.23) with use of H(2)RAs when compared with nonuse of the respective medications. Long-term use of PPIs increased the risk of any fracture (adjusted OR = 1.30; 95% CI, 1.15-1.48) and hip fracture risk (adjusted OR = 1.34; 95% CI, 1.09-1.66), whereas long-term H(2)RA use was not significantly associated with fracture risk. CONCLUSIONS We found possible evidence linking PPI use to an increased risk of fracture, but no association between H(2)RA use and fracture risk. Widespread use of PPIs with the potential risk of fracture is of great importance to public health. Clinicians should carefully consider their decision to prescribe PPIs for patients already having an elevated risk of fracture because of age or other factors.
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Affiliation(s)
- Chun-Sick Eom
- Department of Family Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
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Pouwels S, Lalmohamed A, Souverein P, Cooper C, Veldt BJ, Leufkens HG, de Boer A, van Staa T, de Vries F. Use of proton pump inhibitors and risk of hip/femur fracture: a population-based case-control study. Osteoporos Int 2011; 22:903-10. [PMID: 20585937 PMCID: PMC3034906 DOI: 10.1007/s00198-010-1337-8] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2010] [Accepted: 05/31/2010] [Indexed: 12/19/2022]
Abstract
UNLABELLED Previous studies evaluated the association between proton pump inhibitor (PPI) use and subsequent fracture risk, but they showed ambiguous results. Therefore, the objective was to evaluate this association in a different study population. Our findings show that there is probably no causal relationship between PPI use and hip fracture risk. INTRODUCTION Previous studies evaluated the association between PPI use and subsequent fracture risk, but they showed ambiguous results. To further test these conflicting results, the objective of this study was to evaluate the association between the use of PPIs and the risk of hip/femur fracture in a different study population. METHODS A case-control study was conducted using data from the Dutch PHARMO record linkage system. The study population included 6,763 cases aged 18 years and older with a first hip/femur fracture during enrollment and 26,341 age-, gender- and region-matched controls. RESULTS Current users of PPIs had an increased risk of hip/femur fracture yielding an adjusted odds ratio (AOR) of 1.20 (95% CI 1.04-1.40). Fracture risk attenuated with increasing durations of use, resulting in AORs of 1.26 (95% CI 0.94-1.68) in the first 3 months, 1.31 (95% CI 0.97-1.75) between 3 and 12 months, 1.18 (95% CI 0.92-1.52) between 13 and 36 months and 1.09 (95% CI 0.81-1.47) for use longer than 36 months. CONCLUSION Our findings show that there is probably no causal relationship between PPI use and hip fracture risk. The observed association may be the result of unmeasured distortions: although current use of PPIs was associated with a 1.2-fold increased risk of hip/femur fracture, the positive association was attenuated with longer durations of continuous use. Our findings do not support that discontinuation of PPIs decreases risk of hip fracture in elderly patients.
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Affiliation(s)
- S. Pouwels
- Division of Pharmacoepidemiology and Pharmacotherapy, Utrecht Institute for Pharmaceutical Sciences, Universiteit Utrecht, P.O. Box 80082, 3508 TB Utrecht, The Netherlands
| | - A. Lalmohamed
- Division of Pharmacoepidemiology and Pharmacotherapy, Utrecht Institute for Pharmaceutical Sciences, Universiteit Utrecht, P.O. Box 80082, 3508 TB Utrecht, The Netherlands
| | - P. Souverein
- Division of Pharmacoepidemiology and Pharmacotherapy, Utrecht Institute for Pharmaceutical Sciences, Universiteit Utrecht, P.O. Box 80082, 3508 TB Utrecht, The Netherlands
| | - C. Cooper
- MRC Epidemiology Resource Centre, University of Southampton, Southampton General Hospital, Southampton, UK
- Institute of Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - B. J. Veldt
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - H. G. Leufkens
- Division of Pharmacoepidemiology and Pharmacotherapy, Utrecht Institute for Pharmaceutical Sciences, Universiteit Utrecht, P.O. Box 80082, 3508 TB Utrecht, The Netherlands
| | - A. de Boer
- Division of Pharmacoepidemiology and Pharmacotherapy, Utrecht Institute for Pharmaceutical Sciences, Universiteit Utrecht, P.O. Box 80082, 3508 TB Utrecht, The Netherlands
| | - T. van Staa
- Division of Pharmacoepidemiology and Pharmacotherapy, Utrecht Institute for Pharmaceutical Sciences, Universiteit Utrecht, P.O. Box 80082, 3508 TB Utrecht, The Netherlands
- MRC Epidemiology Resource Centre, University of Southampton, Southampton General Hospital, Southampton, UK
- General Practice Research Database, Medicines and Healthcare Products Regulatory Agency, London, UK
| | - F. de Vries
- Division of Pharmacoepidemiology and Pharmacotherapy, Utrecht Institute for Pharmaceutical Sciences, Universiteit Utrecht, P.O. Box 80082, 3508 TB Utrecht, The Netherlands
- MRC Epidemiology Resource Centre, University of Southampton, Southampton General Hospital, Southampton, UK
- General Practice Research Database, Medicines and Healthcare Products Regulatory Agency, London, UK
- Present Address: Utrecht Institute for Pharmaceutical Sciences, Universiteit Utrecht, Sorbonnelaan 16, 3584 CA Utrecht, The Netherlands
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Akkaya N, Akkaya S, Polat Y, Turk M, Turk T, Ergur S, Sahin F. Helicobacter Pylori Seropositivity in Patients with Postmenopausal Osteoporosis. J Phys Ther Sci 2011. [DOI: 10.1589/jpts.23.61] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Nuray Akkaya
- Department of Physical Medicine and Rehabilitation, Pamukkale University, Medical School
| | - Semih Akkaya
- Department of Orthopedics and Traumatology, Pamukkale University Medical School
| | - Yusuf Polat
- Denizli Clinical Microbiology, Government Hospital
| | - Meral Turk
- Denizli Clinical Parasitology, Government Hospital
| | - Tufan Turk
- Denizli Clinic of Rheumatology, Government Hospital
| | - Sadik Ergur
- Denizli Clinical of Nucleer Medicine, Government Hospital
| | - Fusun Sahin
- Department of Physical Medicine and Rehabilitation, Pamukkale University, Medical School
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Abstract
Aromatase is a specific component of the cytochrome P450 enzyme system that is responsible for the transformation of C19 androgen precursors into C18 estrogenic compounds. This enzyme is encoded by the CYP19A1 gene located at chromosome 15q21.2, that is expressed in ovary and testis not only but also in many extraglandular sites such as the placenta, brain, adipose tissue, and bone. The regulation of the level and activity of aromatase determines the levels of estrogens that have endocrine, paracrine, and autocrine effects on target issues including bone. Importantly, extraglandular aromatization of circulating androgen precursors is the major source of estrogen not only in men (since only 15% of circulating estradiol is released directly by the testis) but also in women after the menopause. Several lines of clinical and experimental evidence now clearly indicate that aromatase activity and estrogen production are necessary for longitudinal bone growth, attainment of peak bone mass, the pubertal growth spurt, epiphyseal closure, and normal bone remodeling in young individuals. Moreover, with aging, individual differences in aromatase activity and thus in estrogen levels may significantly affect bone loss and fracture risk in both genders.
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33
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Papamichael KX, Papaioannou G, Karga H, Roussos A, Mantzaris GJ. Helicobacter pylori infection and endocrine disorders: Is there a link? World J Gastroenterol 2009; 15:2701-7. [PMID: 19522019 PMCID: PMC2695884 DOI: 10.3748/wjg.15.2701] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Helicobacter pylori (H pylori) infection is a leading world-wide infectious disease as it affects more than half of the world population and causes chronic gastritis, peptic ulcer disease and gastric malignancies. The infection elicits a chronic cellular inflammatory response in the gastric mucosa. However, the effects of this local inflammation may not be confined solely to the digestive tract but may spread to involve extra-intestinal tissues and/or organs. Indeed, H pylori infection has been epidemiologically linked to extra-digestive conditions and diseases. In this context, it has been speculated that H pylori infection may be responsible for various endocrine disorders, such as autoimmune thyroid diseases, diabetes mellitus, dyslipidemia, obesity, osteoporosis and primary hyperparathyroidism. This is a review of the relationship between H pylori infection and these endocrine disorders.
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Kakehasi AM, Rodrigues CB, Carvalho AV, Barbosa AJA. Chronic gastritis and bone mineral density in women. Dig Dis Sci 2009; 54:819-24. [PMID: 18685818 DOI: 10.1007/s10620-008-0417-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2008] [Accepted: 06/18/2008] [Indexed: 12/16/2022]
Abstract
We conducted a cross-sectional study of bone mineral density in women with Helicobacter pylori gastritis or autoimmune gastritis. Eighty-five patients were enrolled: 24 patients (mean age 55.2 +/- 13.5 years) with autoimmune gastritis, 34 patients (mean age 63.7 +/- 7.3 years) with H. pylori gastritis, and 27 H. pylori-negative patients with normal gastric mucosa (mean age 62.5 +/- 7.0 years). Gastric mucosa was evaluated by histology and immunohistochemistry. Bone mineral density was measured by dual-energy X-ray absorptiometry. Autoimmune gastritis patients presented severe gastric body mucosa atrophy, based on the absence of parietal cells in 15 (62.5%) patients and the presence of only scattered parietal cells in the remaining nine (37.5%) patients. Among the H. pylori gastritis patients, 21 (62%) presented with different degrees of gastric mucosa atrophy. Bone mineral densities (mean +/- SD, g/mm(2)) were not different among patients with autoimmune gastritis and H. pylori gastritis and the controls. Our results suggest that H. pylori-associated gastritis and autoimmune gastritis would not to be risk factors for decreased bone mineral density in women.
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Affiliation(s)
- Adriana M Kakehasi
- Laboratory of Digestive and Neuroendocrine Pathology, Belo Horizonte, Brazil
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Roux C, Briot K, Gossec L, Kolta S, Blenk T, Felsenberg D, Reid DM, Eastell R, Glüer CC. Increase in vertebral fracture risk in postmenopausal women using omeprazole. Calcif Tissue Int 2009; 84:13-9. [PMID: 19023510 DOI: 10.1007/s00223-008-9188-4] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2008] [Accepted: 10/19/2008] [Indexed: 01/08/2023]
Abstract
Proton pump inhibitors are taken by millions of patients for prevention and treatment of gastroesophageal diseases. Case-control studies have suggested that use of omeprazole is associated with an increased risk of hip fractures. The aim of this prospective study was to assess the risk of vertebral fractures in postmenopausal women using omeprazole. We studied 1,211 postmenopausal women enrolled in the Osteoporosis and Ultrasound Study from the general population. Information on omeprazole and other risk factors for fractures including prevalent fractures and bone mineral density was obtained at baseline. Vertebral fractures were assessed on X-rays obtained at baseline and at the end of the 6-year follow-up and analyzed centrally. At baseline, 5% of this population was using omeprazole. Age-adjusted rates for vertebral fractures were 1.89 and 0.60 for 100 person-years for omeprazole users and nonusers, respectively (P = 0.009). In the multivariate analysis, omeprazole use was a significant and independent predictor of vertebral fractures (RR = 3.50, 95% CI 1.14-8.44). The other predictors were age higher than 65 years (RR = 2.34, 95% CI 1.02-5.34), prevalent vertebral fractures (RR = 3.62, 95% CI 1.63-8.08), and lumbar spine T score </= -2.5 (RR = 2.38, 95% CI 1.03-5.49). Omeprazole use is associated with an increased risk of vertebral fractures in postmenopausal women. Further studies are required to determine the mechanism of the association between the underlying gastric disease, omeprazole use, and risk of osteoporotic fractures.
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Affiliation(s)
- Christian Roux
- Rheumatology Department, AP-HP Cochin Hospital, Paris Descartes University, 27 rue Faubourg Saint Jacques, Paris 75014, France.
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Kakehasi AM, Mendes CMC, Coelho LGV, Castro LP, Barbosa AJA. The presence of Helicobacter Pylori in postmenopausal women is not a factor to the decrease of bone mineral density. ARQUIVOS DE GASTROENTEROLOGIA 2007; 44:266-70. [DOI: 10.1590/s0004-28032007000300016] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2006] [Accepted: 05/10/2007] [Indexed: 11/22/2022]
Abstract
BACKGROUND: Osteoporosis affects approximately 30% of postmenopausal women. Gastrectomy, pernicious anemia, and more recently Helicobacter pylori infection, have all been implicated in the pathogenesis of osteoporosis. A reduced parietal cell mass is a common feature in these conditions. AIM: To study a possible relationship between chronic gastritis, parietal cell density of the oxyntic mucosa and bone mineral density in postmenopausal women, as chronic gastritis, Helicobacter pylori infection and osteoporosis are frequently observed in the elderly. METHODS: Fifty postmenopausal women (61.7 ± 7 years) were submitted to gastroduodenal endoscopy and bone densitometry by dual energy X-ray absorptiometry. Glandular atrophy was evaluated objectively by the determination of parietal cell density. Helicobacter pylori infection was evaluated by histology, urease test and breath test with 13C. RESULTS: Thirty-two patients (64%) presented chronic multifocal gastritis, and 20 of them (40%) showed signs of gastric mucosa atrophy. Lumbar spine osteoporosis was found in 18 patients (36%). The parietal cell density in patients with and without osteoporosis was 948 ± 188 and 804 ± 203 cells/mm², respectively. Ten osteoporotic patients (55%) and 24 non-osteoporotic patients (75%) were infected by Helicobacter pylori. CONCLUSION: Postmenopausal women with osteoporosis presented a well-preserved parietal cell density in comparison with their counterparts without osteoporosis. Helicobacter pylori infection was not different between the two groups. We concluded that neither atrophic chronic gastritis nor Helicobacter pylori seem to be a reliable risk factor to osteoporosis in postmenopausal women.
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Affiliation(s)
| | | | | | - Luiz P. Castro
- Federal University of Minas Gerais School of Medicine, Brazil
| | - Alfredo J. A. Barbosa
- Federal University of Minas Gerais School of Medicine; Federal University of Minas Gerais School of Medicine, Brazil
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Ozdem S, Akcam M, Yilmaz A, Gultekin M, Artan R. Biochemical markers of bone metabolism in children with Helicobacter pylori infection. Dig Dis Sci 2007; 52:967-72. [PMID: 17318389 DOI: 10.1007/s10620-006-9292-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2006] [Accepted: 03/02/2006] [Indexed: 12/23/2022]
Abstract
We investigated the biochemical markers of bone metabolism in children with Helicobacter pylori infection. Biochemical markers of bone metabolism and serum levels of vitamin B12, ferritin and estradiol were measured in 41 H. pylori-positive (+) children (23 girls, 18 boys; aged 11.8+/-3 years). Serum levels of intact parathyroid hormone, ss-collagen I carboxy terminal telopeptide, total alkaline phosphatase (ALP), bone-specific ALP, N-terminal cross-links of human procollagen type I, N-mid-osteocalcin, calcium, phosphate, ferritin, and estradiol did not differ significantly between H. pylori(+) and H. pylori negative (-) children. Vitamin B12 levels were significantly decreased in H. pylori(+) compared to H. pylori(-) children. H. pylori infection was not accompanied by significant changes in markers of bone metabolism in children, although vitamin B12 levels were decreased. Further studies are required to clarify whether H. pylori infection causes time-dependent changes in bone turnover markers during the long course of this inflammatory disease.
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Affiliation(s)
- Sebahat Ozdem
- Central Laboratory, Clinical Biochemistry Unit, Akdeniz University, Medical Faculty, 07070 Antalya, Turkey.
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Gennari L, Nuti R, Bilezikian JP. Estrogen in men: effects on bone accrual, maintenance and prevention of bone loss. Expert Rev Endocrinol Metab 2006; 1:281-295. [PMID: 30754147 DOI: 10.1586/17446651.1.2.281] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Sex steroid hormones play an important role in the maintenance of bone mass in males as well as in females. Even though androgens represent the major sex steroid class in men, their primacy in regulating male skeletal remodeling has been questioned increasingly as direct and indirect evidence has emerged suggesting that estrogens also play a major role in male skeletal health. This review summarizes clinical and experimental evidence that estrogens are essential for bone accrual in the growing skeleton, maintenance of bone mass and prevention of bone loss in men.
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Affiliation(s)
- Luigi Gennari
- a University of Siena, Department of Internal Medicine, Endocrine-Metabolic Sciences and Biochemistry, Policlinico Le Scotte, Viale Bracci, Siena 53100, Italy.
| | - Ranuccio Nuti
- b University of Siena, Department of Internal Medicine, Endocrine-Metabolic Sciences and Biochemistry, Policlinico Le Scotte, Viale Bracci, Siena 53100, Italy.
| | - John P Bilezikian
- c Columbia University, Departments of Medicine and Pharmacology, College of Physicians and Surgeons, 630 W. 168 Street, NY 10032, USA.
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