Increased Risk of Osteoporosis in Patients With Peptic Ulcer Disease

Wu, Chieh‐Hsin; Tung, Yi‐Ching; Chai, Chee‐Yin; Lu, Ying‐Yi; Su, Yu-Feng; Tsai, Tai-Hsin; Kuo, Keng-Liang; Lin, Chih-Lung

doi:10.1097/md.0000000000003309

Cited by 26 publications

(30 citation statements)

References 46 publications

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“…8 Wu et al, in their study on peptic ulcer patients receiving PPIs reported that the osteoporotic effect was more in young males. 17 Our findings were in accordance with that, where osteopenia and osteoporosis were significantly correlated in patients receiving PPIs with male gender, decrease in patient age, and the correlation was highly significant with the duration of use of the drug. In control group of our study, there was a significant decrease in bone density but significantly less than those receiving PPIs and this decrease was significantly correlated with the female gender and increase in age.…”

Section: Discussionsupporting

confidence: 92%

“…16 The results of our study showed also that, the number of patients which can be categorized as osteopenic or osteoporotic patients was significantly higher in the PPIs group than in control group. Similar results were obtained in the studies of Yang et al, Yu et al, and Targowniket al 8,17,18 Biochemical markers are simple tools to follow up patients at risk for bone resorption, Atalay et al revealed in his study that serum ALP level (bone formation marker), may be useful to monitor and follow-up osteoporotic changes that currently cannot be assessed with BMD 19 .The present study revealed that mean level of serum ALP was elevated in both groups but it is significantly higher in patients receiving PPIs than control patients with a significant correlation between the ALP level and the decrease in BMD. Mizunashi et al in their study on effect of the inhibitor of H+,K(+)-ATPase (omeprazole), on bone resorption in humans, found that there was a significant increase in the serum alkaline phosphatase in the studied patient.…”

Section: Discussionsupporting

confidence: 91%

“…Previous studies verified that fragility fractures are commoner in patients with prolonged use of PPIs than in normal population which meets the findings in our study. [4][5][6][7][8]17 Yang et al reported in their study that the risk of decrease in BMD and in turn fragility fractures progressively increased with the duration of PPI treatment and these findings were stronger in men than in women. 8 Wu et al, in their study on peptic ulcer patients receiving PPIs reported that the osteoporotic effect was more in young males.…”

Section: Discussionmentioning

confidence: 99%

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Risk of Osteoporosis and Osteopenia in Patients with Prolonged Use of Proton Pump Inhibitors

Al-Zahrany

Mourgi

2016

Egyptian Journal of Hospital Medicine

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Background and aim of the work: several studies suggest that proton pump inhibitors (PPIs) use may be involved in development and acceleration of osteoporosis. The aim of this study is to investigate the relationships between prolonged uses of PPIs in patients with gastro-esophageal reflux disease (GERD) and to reveal their possible role in development of osteopenia or osteoporosis with evaluation of different diagnostic tools which help in follow up of those patients. Patient and methods: This prospective controlled study which was conducted at King Abdul Aziz Specialist Hospital in Taif, Saudi Arabia, from January 2013 to June 2016. We compared the prevalence of osteoporosis or osteopenia in 2 groups of individuals, the first group; of 30 patients using PPIs as treatment of GERD for more than 2 years. The second group included thirty healthy control subjects .In both groups we measured the bone mineral density using the dual energy X-ray absorptiometry (DEXA), calcium (Ca), inorganic phosphorus (P), serum alkaline phosphatase, and deoxypyridinoline (DPD) in urine. Results: there were no significant differences between the 2 groups as regards, age, gender, and their clinical history (P > 0.05), however, the history of fragility fracture was significantly higher in PPIs group of patients (P< 0.05). The means of antroposterior spine and left femur BMD-T scores were lower than normal in both groups; however, it was significantly lower in PPIs group than in control group (P< 0.05). Serum calcium was slightly lower than the reference range with normal phosphorus level without significant difference between both groups (P> 0.05). The serum alkaline phosphatase and urinary DPD were higher than normal reference levels, but, significantly higher in patients receiving PPIs (P< 0.05). The number of osteopenic/osteoporotic patients was significantly higher in PPIs group than in control group (P< 0.05). Osteopenia and osteoporosis were significantly correlated in PPIs group with male gender, younger age group of patients (P< 0.05), and the correlation was highly significant with the duration of use of the drug (P<0.001). In control group the decrease in bone density was significantly correlated with the female gender and to older group of patients (P< 0.05). Conclusion: in GERD patient using PPIs, the osteopenic/osteoporotic effect with increased possibility of fragility fractures must be discussed with the patient if prolonged use of these drugs is expected, taking in consideration the potential safety and reliability of laparoscopic or thoracoscopic surgical options as alternative therapy.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

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Risk of Osteoporosis and Osteopenia in Patients with Prolonged Use of Proton Pump Inhibitors

Al-Zahrany

Mourgi

2016

Egyptian Journal of Hospital Medicine

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“…The NHIRD has been used in many studies published in scientific journals. 9–11 The current study used the Longitudinal Health Insurance Database 2010, in which diseases are coded according to the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM).…”

Section: Methodsmentioning

confidence: 99%

Keloid risk in patients with atopic dermatitis: a nationwide retrospective cohort study in Taiwan

et al. 2018

BMJ Open

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ObjectiveThe pathogenesis of keloid is largely unknown. Because keloid and atopic dermatitis have overlapping pathophysiological mechanisms, we aimed to evaluate keloid risk in patients with atopic dermatitis.Study designPopulation-based retrospective cohort study.SettingThe Taiwan National Health Insurance Research Database was used to analyse data for people who had been diagnosed with atopic dermatitis.ParticipantsWe identified 8371 patients with newly diagnosed atopic dermatitis during 1996–2010. An additional 33 484 controls without atopic dermatitis were randomly identified and frequency matched at a one-to-four ratio.Primary and secondary outcome measureThe association between atopic dermatitis and keloid risk was estimated using Cox proportional hazard regression models.ResultsAfter adjustment for covariates, the atopic dermatitis patients have a 3.19-fold greater risk of developing keloid compared with the non-atopic dermatitis group (3.19vs1.07 per 1000 person-years, respectively). During the study period, 163 patients with atopic dermatitis and 532 patients without atopic dermatitis developed keloid. Notably, keloid risk increased with severity of atopic dermatitis, particularly in patients with moderate to severe atopic dermatitis.ConclusionsOur results indicate that patients with atopic dermatitis had a higher than normal risk of developing keloid and suggest that atopic dermatitis may be an independent risk factor for keloid.

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“…Because this study was derived from the health examinations, these subjects may be healthy relatively without any bone deformities. Besides, two studies revealed peptic ulcer disease was an independent risk factor for osteoporosis [ 6 , 29 ]. The mechanism of this association was not clear.…”

Section: Discussionmentioning

confidence: 99%

Relationship between Helicobacter pylori infection and bone mineral density: a retrospective cross-sectional study

et al. 2018

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BackgroundHelicobacter pylori (H. pylori) infection can induce individual inflammatory and immune reactions which associated with extra-digestive disorders. Our aim is to investigate the association between H. pylori infection and bone mineral density.MethodsThis retrospective cross-sectional study was performed by using the data from the health examination database in a medical center of southern Taiwan in 2013. We investigated the relationship between sex, age, body mass index (BMI), waist circumstance, lipid profile, H. pylori infection, the findings of upper gastrointestinal endoscopy and bone mineral density (BMD). Because of nonrandomized assignment and strong confounding effect of age on BMD, the 1:1 propensity score match was applied for age adjustment. The simple and multiple stepwise logistic regression analysis were performed to assess the risk factors of decreased BMD in these well-balanced pairs of participants.ResultsOf the 867 subjects in final analysis with the mean age of 55.9 ± 11.3 years, 381 (43.9%) subjects had H. pylori infection, and 556 (64.1%) subjects had decreased BMD. In decreased BMD group, the portion of woman was higher than a normal BMD group (37.2% versus 29.6%, P = 0.023), the age was significantly older (59.4 ± 9.8 versus 49.8 ± 11.3, p < 0.001) and BMI was significantly lower (24.7 ± 3.5 versus 25.4 ± 3.7, p = 0.006) than the normal BMD group. The prevalence of H. pylori infection was 39.9% and 46.2% in the normal BMD group and the decreased BMD group respectively (P = 0.071). The multivariate analysis which was used for these possible risk factors showed that only advanced age (OR 1.09, 95% CI 1.08–1.11, P < 0.001), and low BMI (OR 0.91, 95% CI 0.87–0.95, P < 0.001) were independently significantly associated with decreased BMD in this nonrandomized study. In the propensity score-matched participants, the multiple stepwise logistic regression analysis revealed H. pylori infection (OR 1.62, 95% CI 1.12–2.35, P = 0.011) and low BMI (OR 0.92, 95% CI 0.87–0.97, P = 0.001) were independently significantly associated with decreased BMD.ConclusionsH. pylori infection and low BMI were independently significantly associated with decreased BMD in selected propensity score-matched populations after age adjustment.

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Increased Risk of Osteoporosis in Patients With Peptic Ulcer Disease

Abstract: Supplemental Digital Content is available in the text

Cited by 26 publications

References 46 publications

Risk of Osteoporosis and Osteopenia in Patients with Prolonged Use of Proton Pump Inhibitors

Risk of Osteoporosis and Osteopenia in Patients with Prolonged Use of Proton Pump Inhibitors

Keloid risk in patients with atopic dermatitis: a nationwide retrospective cohort study in Taiwan

Relationship between Helicobacter pylori infection and bone mineral density: a retrospective cross-sectional study

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