A nationwide population cohort study: irritable bowel syndrome is a risk factor of osteoporosis

Cholestyramine alleviates bone and muscle loss in irritable bowel syndrome via regulating bile acid metabolism

Irritable bowel syndrome (IBS) is a widespread gastrointestinal disorder known for its multifaceted pathogenesis and varied extraintestinal manifestations, yet its implications for bone and muscle health are underexplored. Recent studies suggest a link between IBS and musculoskeletal disorders, but a comprehensive understanding remains elusive, especially concerning the role of bile acids (BAs) in this context. This study aimed to elucidate the potential contribution of IBS to bone and muscle deterioration via alterations in gut microbiota and BA profiles, hypothesizing that cholestyramine could counteract these adverse effects. We employed a mouse model to characterize IBS and analysed its impact on bone and muscle health. Our results revealed that IBS promotes bone and muscle loss, accompanied by microbial dysbiosis and elevated BAs. Administering cholestyramine significantly mitigated these effects, highlighting its therapeutic potential. This research not only confirms the critical role of BAs and gut microbiota in IBS-associated bone and muscle loss but also demonstrates the efficacy of cholestyramine in ameliorating these conditions, thereby contributing significantly to the field's understanding and offering a promising avenue for treatment.

Prevalence of osteoporosis and incidence of related fractures in developed economies in the Asia Pacific region: a systematic review

Robust data on osteoporosis in the Asia Pacific region could improve healthcare decision-making. Osteoporosis affects 10-30% of women aged 40 + , and up to 10% of men in 7 developed economies in Asia Pacific. Fractures affect 500-1000 adults aged 50 + per 100,000 person-years. Policymakers and clinicians must address this problem.

PURPOSE

Osteoporosis and associated fractures result in considerable morbidity, loss of productivity, early mortality, and increased healthcare expenses. Many countries in the Asia Pacific (AP) region, especially middle- and higher-income economies, are faced with aging and increasingly sedentary populations. It is critical to consolidate and analyze the available information on the prevalence and incidence of the disease in these countries.

METHODS

We systematically reviewed articles and gray literature for Australia, China, Hong Kong, Japan, Singapore, South Korea, and Taiwan. We searched PubMed, ScienceDirect, JSTOR, Cochrane, Google Scholar, and other databases for data published 2009-2018. We included articles with prevalence or incidence estimates for adults with osteoporosis or related fractures.

RESULTS

All locations had data available, but of widely varying quantity and quality. Most estimates for osteoporosis prevalence ranged from 10 to 30% for women ages 40 and older, and up to 10% for men. Osteoporotic fracture incidence typically ranged between 500 and 1000 per 100,000 person-years among adults aged 50 and older. Both outcomes typically increased with age and were more common among women.

CONCLUSION

Osteoporosis and associated fractures affect significant portions of the adult population in developed economies in the AP region. Governments and healthcare systems must consider how best to prevent and diagnose osteoporosis, and manage affected individuals, to reduce healthcare costs and mortality associated with fractures.

The Risk of Osteoporosis and Osteoporotic Fracture Following the Use of Irritable Bowel Syndrome Medical Treatment: An Analysis Using the OMOP CDM Database

Patients with irritable bowel syndrome (IBS) are at increased risk of osteoporosis and osteoporotic fracture. This study investigated whether IBS medication attenuated the rate of osteoporosis and osteoporotic fracture risk. We conducted a retrospective large-scale multicenter study across eight hospital databases encoded in the Observational Medical Outcomes Partnership (OMOP) Common Data Model (CDM). The primary outcome was the incidence of osteoporosis, whereas secondary outcomes were osteoporotic fractures. After 1:4 matching, 24,723 IBS patients, 78,318 non-IBS patients, 427,640 non-IBS patients with IBS medication, and 827,954 non-IBS patients without IBS medication were selected. The risk of osteoporosis was significantly increased in the IBS group compared to the non-IBS group (hazard ratio (HR) 1.33; confidence interval (CI) 1.17~1.51). Even in patients who were not diagnosed with IBS, the risk of osteoporosis was significantly increased in those with IBS medication compared to those without (HR 1.77, CI 1.62~1.93). The risk of osteoporotic fracture was significantly increased in the IBS medication group (HR 1.69, CI 1.55~1.84). Patients exposed to IBS treatment even without IBS diagnosis were at increased risk of osteoporosis and osteoporotic fracture. Early diagnosis and treatment of osteoporosis should be considered in patients who have received medication for IBS symptoms.

The association between irritable bowel syndrome and osteoporosis: a systematic review and meta-analysis

BACKGROUND

Recent studies have suggested that irritable bowel syndrome (IBS) could be a risk factor for osteoporosis although the evidence is still limited. The current study aimed to comprehensively examine the risk of osteoporosis among patients with IBS using systematic review and meta-analysis technique.

METHODOLOGY

Literature search was independently conducted by two investigators using MEDLINE, EMBASE, and Google Scholar database up to October 2019. Eligible study must evaluate whether patients with IBS have a higher risk of osteoporosis and/or osteoporotic fracture. It could be either cross-sectional study, case-control study, or cohort study. Point estimates and standard errors from each eligible study were combined together using the generic inverse variance method of DerSimonian and Laird.

RESULTS

Of the 320 articles identified from the three databases, four cohort and one cross-sectional study with 526,633 participants met the eligibility criteria and were included into the meta-analysis. All five studies investigated the risk of osteoporosis among patients with IBS, and the pooled analysis found that patients with IBS had a significantly higher risk of osteoporosis than individuals without IBS with the pooled risk ratio of 1.95 (95% CI, 1.04-3.64; I² 100%). Sensitivity analysis including only cohort studies found a lower RR (pooled RR 1.55; 95% CI, 1.39-1.72) with a lower I² (59%). Three studies investigated the risk of osteoporotic fracture, and the pooled analysis found that patients with IBS also had a higher risk of osteoporotic fracture than individuals without IBS with the pooled risk ratio of 1.58 although statistical significance was not reached (95% CI, 0.95-2.62; I² 99%). Sensitivity analysis including only cohort studies found a lower RR (pooled RR 1.27; 95% CI, 1.20-1.39) with a dramatically lower I² (0%). Limitations included high heterogeneity and reliance on diagnostic codes.

CONCLUSION

A significantly increased risk of osteoporosis among IBS patients was observed in this study. Early intervention to prevent the development of osteoporosis, such as weight-bearing exercise, adequate intake of vitamin D and calcium, and early screening for osteoporosis, may be beneficial to these patients although further studies are still required to confirm the efficacy and cost-effectiveness of this approach.

Risk of fractures at different anatomic sites in patients with irritable bowel syndrome: a nationwide population-based cohort study

This study was to investigate the fracture risk of irritable bowel syndrome (IBS) in comparison with non-IBS group. Our results found that IBS group has increased risk for fracture, in particular of the spine, forearm, hip, and hand.

INTRODUCTION

Patients with IBS might also be at increased risk of osteoporosis and osteoporotic fractures. Up to now, the association between IBS and the risk of fractures at different anatomic sites occurrences is not completely clear. We conducted a population-based cohort analysis to investigate the fracture risk of IBS in comparison with non-IBS group.

METHODS

We identified 29,505 adults aged ≥ 20 years with newly diagnosed IBS using the Taiwan National Health Insurance Research Database in 2000-2012. A comparison group was constructed of patients without IBS who were matched according to gender and age. The occurrence of fracture was monitored until the end of 2013. We analyzed the risk of fracture events to occur in IBS by using Cox proportional hazards regression models.

RESULTS

Patients with IBS had a higher incidence of osteoporotic fractures compared with the non-IBS group (12.34 versus 9.45 per 1000 person-years) and an increased risk of osteoporotic fractures (adjusted hazard ratio [aHR] = 1.27, 95% confidence interval [CI] = 1.20-1.35). Site-specific analysis showed that the IBS group had a higher risk of fractures for spine, forearm, hip, and hand than did the non-IBS group. With further stratification for gender and age, a higher aHR value for osteoporotic fractures in the IBS group was seen across all age groups in males, but seen in elderly females. In addition, female, elderly, low income, hypertension, coronary artery disease, cerebrovascular disease, and depressive disorders as independent osteoporotic fracture risk factors in IBS patients.

CONCLUSIONS

The IBS is considered as a risk factor for osteoporotic fractures, particularly in female individuals and fracture sites located at the spine, forearm, hip, and hand.

An Initial Attack of Urinary Stone Disease Is Associated with an Increased Risk of Developing New-Onset Irritable Bowel Syndrome: Nationwide Population-Based Study

BACKGROUND

The neurotransmitter pathways in irritable bowel syndrome (IBS) and urinary stone attacks are both related to serotonin, and each disease may be influenced by viscero-visceral hyperalgesia. However, the relationship between urinary tract stone disease and IBS has never been addressed. We aimed to investigate the risk of suffering new-onset IBS after an initial urinary stone attack using a nationwide database.

METHODS

A study group enrolled a total of 13,254 patients who were diagnosed with an initial urinary stone attack; a comparison group recruited 39,762 matched non-urinary stone participants during 2003 and 2007. We followed each patient for 3 years to determine new-onset IBS. We also used Cox proportional hazards models to analyze the risk of IBS between the study and comparison groups after modified by demographics, residence, patient characteristics and personal histories.

RESULTS

The occurrence rates of IBS were 3.3% (n = 440) and 2.6% (n = 1,034) respectively in the study and comparison groups. A covariate-adjusted hazard ratio (HR) of IBS in the study group that was 1.28 times greater (HR = 1.29, 95% CI, 1.15-1.44) than that in the comparison group was showed in the stratified Cox proportional analysis. The adjusted HRs of IBS did not decrease after considering demographics and past histories. The majority of IBS (30.5%) occurred within the first 6 months after the stone attack.

CONCLUSION

Patients with an initial urinary stone attack are at increased risk of developing new-onset IBS. The HRs of IBS did not decrease even after adjusting for patient demographics and past histories. Most importantly, 30.5% of IBS occurred within the first 6 months after the urinary stone attack.

Celiac disease and risk of fracture in adults--a review

Patients with celiac disease (CD) have low bone mineral density. Evidence of increased fracture risk in these patients is conflicting, and the indication for bone mineral density screening of all adult CD patients is debated. Our aim was to review current published data on fractures in CD. Cross-sectional cohort studies and one case study were identified by searching Medline and Embase. Although the identified studies are heterogeneous and difficult to compare, the overall findings indicate a positive association between CD and risk of fracture. Adult patients with CD should be considered for bone densitometry in order to estimate fracture risk.