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Osteoporosis International

Published in:

01-04-2013 | Original Article

Increased risk of osteoporosis-related fractures in patients with irritable bowel syndrome

Authors: D. J. Stobaugh, P. Deepak, E. D. Ehrenpreis

Published in: Osteoporosis International | Issue 4/2013

Abstract

Summary

We sought to determine whether patients with irritable bowel syndrome (IBS) have an increased risk of osteoporosis and related fractures using the Nationwide Emergency Department Sample (NEDS). Patients with IBS had increased adjusted odds of osteoporosis and osteoporotic fractures compared to the non-IBS control group, controlling for known risk factors for osteoporosis. Screening measures to identify osteoporosis in this group are advised.

Introduction

Ulcerative colitis, Crohn’s disease, and celiac disease have well-described augmented risk of osteoporosis and related fractures. We sought to determine whether IBS also indicates an increased risk of osteoporosis and related fractures.

Methods

The 2008 NEDS database was used to determine the adjusted odds of osteoporosis and related fractures in IBS patients. Only fractures (pathologic wrist (733.12), vertebrae (733.13), and femur fractures (733.14), traumatic wrist (813.x), vertebrae (805.x–806.x), and hip fractures (820.x–821.x)) with a secondary diagnosis of osteoporosis (733.0x) were included in the analysis. A multivariate logistic regression analysis was performed, controlling for known risk factors for osteoporosis and related fractures.

Results

We identified 317,857 ED visits in patients with a diagnosis of IBS. Of these, 17,752 carried a diagnosis of osteoporosis and 694 IBS patients had a concurrent diagnosis of a pathologic fracture of the wrist, hip, or vertebrae. A total of 1,503 IBS patients had a concurrent diagnosis of a traumatic fracture of the wrist, hip, or vertebra. Overall, patients with IBS had an increased adjusted odds of osteoporosis (odds ratio (OR) 4.28, 95 % confidence interval (CI) 4.21–4.35) and osteoporotic fractures (OR 2.36, CI 2.26–2.47) compared to the non-IBS control group. The highest adjusted odds of fracture was seen at the wrist (OR 2.41, CI 2.10–2.77 compared to controls).

Conclusions

IBS patients are at an increased risk of osteoporosis and related fractures. Screening measures to identify osteoporosis and prevent fractures are advised.

Kanis JA, Melton LJ 3rd, Christiansen C, Johnston CC, Khaltaev N (1994) The diagnosis of osteoporosis. J Bone Miner Res 9(8):1137–1141PubMedCrossRef

Johnell O, Kanis JA (2006) An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporos Int 17(12):1726–1733PubMedCrossRef

Adachi JD, Adami S, Gehlbach S, Anderson FA Jr, Boonen S, Chapurlat RD, Compston JE, Cooper C, Delmas P, Díez-Pérez A, Greenspan SL, Hooven FH, LaCroix AZ, Lindsay R, Netelenbos JC, Wu O, Pfeilschifter J, Roux C, Saag KG, Sambrook PN, Silverman S, Siris ES, Nika G, Watts NB, GLOW Investigators (2010) Impact of prevalent fractures on quality of life: baseline results from the global longitudinal study of osteoporosis in women. Mayo Clin Proc 85(9):806–813PubMedCrossRef

Ioannidis G, Papaioannou A, Hopman WM, Akhtar-Danesh N, Anastassiades T, Pickard L, Kennedy CC, Prior JC, Olszynski WP, Davison KS, Goltzman D, Thabane L, Gafni A, Papadimitropoulos EA, Brown JP, Josse RG, Hanley DA, Adachi JD (2009) Relation between fractures and mortality: results from the Canadian Multicentre Osteoporosis Study. CMAJ 181(5):265–271PubMed

Kanis JA, Johnell O, Oden A, Dawson A, De Laet C, Jonsson B (2001) Ten year probabilities of osteoporotic fractures according to BMD and diagnostic thresholds. Osteoporos Int 12(12):989–995PubMedCrossRef

Kanis JA, Johnell O, De Laet C, Johansson H, Oden A, Delmas P, Eisman J, Fujiwara S, Garnero P, Kroger H, McCloskey EV, Mellstrom D, Melton LJ, Pols H, Reeve J, Silman A, Tenenhouse A (2004) A meta-analysis of previous fracture and subsequent fracture risk. Bone 35(2):375–382PubMedCrossRef

Van Staa TP, Leufkens HG, Abenhaim L, Zhang B, Cooper C (2000) Use of oral corticosteroids and risk of fractures. J Bone Miner Res 15(6):993–1000PubMedCrossRef

Ensrud KE, Cauley J, Lipschutz R, Cummings SR (1997) Weight change and fractures in older women. Study of Osteoporotic Fractures Research Group. Arch Intern Med 157(8):857–863PubMedCrossRef

Cummings SR, Nevitt MC, Browner WS, Stone K, Fox KM, Ensrud KE, Cauley J, Black D, Vogt TM (1995) Risk factors for hip fracture in white women. Study of Osteoporotic Fractures Research Group. N Engl J Med 332(12):767–773PubMedCrossRef

10.

Kanis JA, Johnell O, Oden A, Johansson H, De Laet C, Eisman JA, Fujiwara S, Kroger H, McCloskey EV, Mellstrom D, Melton LJ, Pols H, Reeve J, Silman A, Tenenhouse A (2005) Smoking and fracture risk: a meta-analysis. Osteoporos Int 16(2):155–162PubMedCrossRef

11.

Kanis JA, Johansson H, Johnell O, Oden A, De Laet C, Eisman JA, Pols H, Tenenhouse A (2005) Alcohol intake as a risk factor for fracture. Osteoporos Int 16(7):737–742PubMedCrossRef

12.

Compston JE, Judd D, Crawley EO, Evans WD, Evans C, Church HA, Reid EM, Rhodes J (1987) Osteoporosis in patients with inflammatory bowel disease. Gut 28(4):410–415PubMedCrossRef

13.

Green PH, Cellier C (2007) Celiac disease. N Engl J Med 357:1731–1743PubMedCrossRef

14.

Corazza GR, Di Sario A, Cecchetti L, Jorizzo R, Di Stefano M, Minguzzi L, Brusco G, Bernardi M, Gasbarrini G (1996) Influence of pattern of clinical presentation and of gluten-free diet on bone mass and metabolism in adult coeliac disease. Bone 18(6):525PubMedCrossRef

15.

Bjarnason I, Macpherson A, Mackintosh C, Buxton-Thomas M, Forgacs I, Moniz C (1997) Reduced bone density in patients with inflammatory bowel disease. Gut 40(2):228–233PubMed

16.

Bernstein M, Irwin S, Greenberg GR (2005) Maintenance infliximab treatment is associated with improved bone mineral density in Crohn’s disease. Am J Gastroenterol 100(9):2031–2035PubMedCrossRef

17.

Liebregts T, Adam B, Bredack C, Röth A, Heinzel S, Lester S, Downie-Doyle S, Smith E, Drew P, Talley NJ, Holtmann G (2007) Immune activation in patients with irritable bowel syndrome. Gastroenterology 132(3):913–920PubMedCrossRef

18.

Whitehead WE, Palsson OS, Levy RR, Feld AD, Turner M (2007) Comorbidity in irritable bowel syndrome. Am J Gastroenterol 102:2767–2776PubMedCrossRef

19.

Gass M, Dawson-Hughes B (2006) Preventing osteoporosis-related fractures: an overview. Am J Med 119(4 Suppl 1):S3–S11PubMedCrossRef

20.

Lippuner K, von Overbeck J, Perrelet R, Bosshard H, Jaeger P (1997) Incidence and direct medical costs of hospitalizations due to osteoporotic fractures in Switzerland. Osteo Int 7(5):414–425CrossRef

21.

Schafer JL (1999) Multiple imputation: a primer. Stat Methods Med Res 8(1):3–15PubMedCrossRef

22.

Yadav VK, Ryu J, Suda N, Tanaka KF, Gingrich JA (2008) Lrp5 controls bone formation by inhibiting serotonin synthesis in the duodenum. Cell 135:825–837PubMedCrossRef

23.

Gershon MD, Tack J (2007) The serotonin signaling system: from basic understanding to drug development for functional GI disorders. Gastroenterology 132(1):397–414PubMedCrossRef

24.

Cremon C, Carini G, Wang B, Vasina V, Cogliandro RF, De Giorgio R, Stanghellini V, Grundy D, Tonini M, De Ponti F, Corinaldesi R, Barbara G (2011) Intestinal serotonin release, sensory neuron activation, and abdominal pain in irritable bowel syndrome. Am J Gastroenterol 106(7):1290–1298PubMedCrossRef

25.

Gibson PR, Shepherd SJ (2010) Evidence-based dietary management of functional gastrointestinal symptoms: the FODMAP approach. J Gastroenterol Hepatol 25(2):252–258PubMedCrossRef

26.

Vesa TH, Seppo LM, Marteau PR, Sahi T, Korpela R (1998) Role of irritable bowel syndrome in subjective lactose intolerance. Am J Clin Nutr 67(4):710–715PubMed

27.

Diem SJ, Blackwell TL, Stone KL, Yaffe K, Haney EM, Bliziotes MM, Ensrud KE (2007) Use of antidepressants and rates of hip bone loss in older women: the study of osteoporotic fractures. Arch Intern Med 167(12):1240–1245PubMedCrossRef

28.

Haney EM, Chan BK, Diem SJ, Ensrud KE, Cauley JA, Barrett-Connor E, Orwoll E, Bliziotes MM (2007) Association of low bone mineral density with selective serotonin reuptake inhibitor use by older men. Arch Intern Med 167(12):1246–1251PubMedCrossRef

29.

Richards JB, Papaioannou A, Adachi JD, Joseph L, Whitson HE, Prior JC, Goltzman D (2007) Effect of selective serotonin reuptake inhibitors on the risk of fracture. Arch Intern Med 167(2):188–194PubMedCrossRef

30.

Clouse RE, Lustman PJ (2005) Use of psychopharmacological agents for functional gastrointestinal disorders. Gut 54(9):1332–1341PubMedCrossRef

31.

Chang L, Adeyemo M, Karagiannidis I, Videlock EJ, Bowe C, Shih W, Presson AP, Yuan PQ, Cortina G, Gong H, Singh S, Licudine A, Mayer M, Tache Y, Pothoulakis C, Mayer EA (2012) Serum and colonic mucosal immune markers in irritable bowel syndrome. Am J Gastroenterol 107:262–272PubMedCrossRef

32.

Schmulson M, Chey WD (2012) Editorial: abnormal immune regulation and low-grade inflammation in ibs: does one size fit all? Am J Gastroenterol 107:273–275PubMedCrossRef

33.

Longstreth GF, Thompson WG, Chey WD, Houghton LA, Mearin F, Spiller RC (2006) Functional bowel disorders. Gastroenterology 130(5):1480–1491PubMedCrossRef

34.

Manning AP, Thompson WG, Heaton KW, Morris AF (1978) Towards positive diagnosis of the irritable bowel. Br Med J 2(6138):653–654PubMedCrossRef

35.

Kruis W, Thieme C, Weinzierl M, Schüssler P, Holl J, Paulus W (1984) A diagnostic score for the irritable bowel syndrome. Its value in the exclusion of organic disease. Gastroenterology 87(1):1–7PubMed

36.

American College of Gastroenterology Task Force on Irritable Bowel Syndrome, Brandt LJ, Chey WD, Foxx-Orenstein AE, Schiller LR, Schoenfeld PS, Spiegel BM, Talley NJ, Quigley EM (2009) An evidence-based position statement on the management of irritable bowel syndrome. Am J Gastroenterol 104(Suppl 1):S1–S35PubMed

37.

Ananthakrishnan AN, McGinley EL, Binion DG, Saeian K (2011) Fracture-associated hospitalizations in patients with inflammatory bowel disease. Dig Dis Sci 56(1):176–182PubMedCrossRef

38.

Kanis JA, on behalf of the World Health Organization Scientific Group. Assessment of osteoporosis at the primary health-care level. WHO Collaborating Centre for Metabolic Bone Diseases, University of Sheffield 2007

39.

Bischoff-Ferrari HA, Dietrich T, Orav EJ, Dawson-Hughes B (2004) Positive association between 25-hydroxy vitamin D levels and bone mineral density: a population-based study of younger and older adults. Am J Med 116(9):634–639PubMedCrossRef

Title: Increased risk of osteoporosis-related fractures in patients with irritable bowel syndrome
Authors: D. J. Stobaugh
P. Deepak
E. D. Ehrenpreis
Publication date: 01-04-2013
Publisher: Springer-Verlag
Published in: Osteoporosis International / Issue 4/2013
Print ISSN: 0937-941X
Electronic ISSN: 1433-2965
DOI: https://doi.org/10.1007/s00198-012-2141-4

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Increased risk of osteoporosis-related fractures in patients with irritable bowel syndrome

Abstract

Summary

Introduction

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Summary

Introduction

Methods

Results

Conclusions

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