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

Abstract

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.

Helicobacter pylori Related Diseases and Osteoporotic Fractures (Narrative Review)

“…The second report [ 125 ], based on analysis of 50,002 patients with PUD and equal number of controls matched by age, gender, past medical history, income and residence region, found increased risk of OP in PUD regardless of gender (adjusted HR 1.36, 95% CI 1.33–1.40). In contrast, a retrospective cross-sectional study from China ( n = 867, with PUD 351 patient) reported that PUD was significantly associated with decreased BMD only in univariate analysis (OR 1.37, 95% CI 1.03–1.82) [ 117 ]. Lastly, in a cohort of patients operated for PUD between 1956 and 1985 (pre-HPI era) and followed for 30 years, the risk of OF was significantly (and independently of surgical procedure type) increased showing a standardized incidence ratio of 2.5 for the proximal femur, 4.7 for vertebra and 2.2 for the distal forearm [ 126 ].…”

“…Low serum B12 levels affect DNA synthesis, an important factor for bone remodeling. Vitamin B12 (and other B vitamins—B2, B6 and folate—linked to homocysteine metabolism) is regarded an essential factor for bone health [ 117 , 152 , 153 , 154 , 155 , 156 , 157 , 158 , 159 , 160 , 161 ]. Vitamin B12 deficiency was reported to have an increased fracture risk: 1.7- to [ 162 ] 1.9-fold [ 163 ] for hip fracture, 1.8-fold for vertebral fracture [ 163 ] and 2.9-fold for distal forearm fracture [ 163 ].…”

“…Several studies reported an association between GERD and vertebral fractures or kyphosis [ 256 , 257 , 258 ]. The most recent publications, however, did not confirm that GERD and decreased BMD are linked [ 117 ], neither that the incidence of OFs is higher among subjects with BO [ 259 ] (Kumar S 2017). As in the total population, older age, female gender and a higher comorbidity index were the independent risk factors for OFs in patients with BO.…”

H. Pylori is related to osteoporosis but only in premenopausal female: a cross-sectional study

“…Most studies hold the view that obesity is related to osteoporosis [29]. It is generally believed that obesity may be a protective factor against bone loss and osteoporosis [30].…”

<p>The Skeletal Effects of Short-Term Triple Therapy in a Rat Model of Gastric Ulcer Induced by <em>Helicobacter pylori</em> Infection</p>

“…Epidemiological studies on the relationship between H. pylori infection and osteoporosis have yielded heterogeneous findings so far, whereby positive 15,16 and negligible associations 17,18 have been reported. A recent meta-analysis showed that H. pylori infection was associated with osteoporosis [odds ratio (95% confidence interval): 1.39 (1.13--1.71)] but not significantly with BMD at the hip, lumbar and femur.…”