Prevalence of Helicobacter pylori Infection in Male Patients with Osteoporosis and Controls

Abstract

Cytokines that regulate bone turnover (tumor necrosis factor-alpha, interleukin-6, etc.) may influence the pathogenesis of skeleton disorders, such as osteoporosis. Since Helicobacter pylori infection increases the systemic levels of inflammatory cytokines, we investigated the possibility that this infection increases the risk of developing osteoporosis and affects the bone metabolism in a group of male patients with osteoporosis. We examined 80 osteoporotic male patients and 160 controls for serum antibodies to H. pylori and the CagA protein and determined, in patients alone, the most important biochemical and instrumental parameters of the disease. Fifty-one patients (63.7%) and 107 controls (66.8%) were seropositive for H. pylori infection (nonsignificant); 30 infected patients (58.8%) and 43 infected controls (40.1%) were positive for anti-CagA antibodies (P = 0.028; OR = 2.13). Levels of estradiol in infected CagA-positive patients were significantly lower than in infected CagA-negative patients (28.5 [SD = 10.18] vs. 39.5 [SD = 14.50] pg/ml; P = 0.002) and uninfected patients (35.2 [SD = 12.7] pg/ml; P = 0.028). Levels of urinary cross-laps(a marker of bone resorption) were increased in patients infected by CagA-positive strains compared to patients infected by CagA-negative strains (282.9 [SD = 103.8] vs. 210.5 [SD = 150.1]microg/mmol; P = 0.048) and uninfected patients (204.3 [SD = 130.1] microg/mmol; P = 0.016). Differences among uninfected and infected patients, independent of CagA status, were observed for other markers of bone turnover, but they did not reach statistical significance. Infection by CagA-positive H. pylori strains is more prevalent in men with osteoporosis, who show reduced systemic levels of estrogens and increased bone turnover. H. pylori infection by strains expressing CagA may therefore be considered a risk factor for osteoporisis in men.

Helicobacter Pylori Seropositivity in Patients with Postmenopausal Osteoporosis

“…Figura et al 18) evaluated 80 osteoporotic males, and 160 healthy males for antibodies to HP, hormone levels and bone turnover markers and measured HP strains expressing Cag A antibodies in HP seropositive patients and controls. They found that HP seropositivity was not different but Cag A expressing HP seropositivity was significantly different between groups.…”

“…They found that HP seropositivity was not different but Cag A expressing HP seropositivity was significantly different between groups. Therefore, Figura et al 18) proposed that HP strains expressing Cag A might increase the risk of osteoporosis in male patients by reducing the systemic levels of estrogens. They also proposed that bone resorption in patients infected with Cag A-positive HP strains, was higher than in those infected with Cag A-negative HP strains and HP negative cases.…”

“…TNF-alpha and IL-6 were previously proposed as being part of the etiology of osteoporosis and the prevalence of HP infection increases with age 2,16) . In this context, some studies exploring the role of HP in osteoporosis have been conducted 3,17,18) . Since the results of these studies about the r o l e o f H P i n p o s t m e n o p a u s a l o s t e o p o r o s i s a r e contradictory 3,17) , we examined HP seropositivity in postmenopausal osteoporotic and nonosteoporotic patients.…”

Use of Acid-Suppressive Drugs and Risk of Fracture: A Meta-analysis of Observational Studies

“…Bone alteration may be related to the underlying gastric disease. The prevalence of H pylori infection has been found to be high in men with osteoporosis, 62 and this infection may be present in patients taking ASDs. H pylori infection can induce a permanent infl ammatory response, that is, a gastric and systemic increase in indexes of infl ammation.…”

“…This mechanism has been implicated in some extragastric manifestations in H pylori-infected patients. 62 A major limitation of our meta-analysis of observational studies is the possibility of uncontrolled confounding. Our fi ndings should therefore be confi rmed by further prospective studies including RCTs that are designed specifi cally with large sample sizes and long follow-up durations to test the effect of ASDs on the risk of fracture.…”