Abstract
Osteoporosis (OP) and osteoporotic fractures (OFs) are common multifactorial and heterogenic disorders of increasing incidence. Helicobacter pylori (H.p.) colonizes the stomach approximately in half of the world’s population, causes gastroduodenal diseases and is prevalent in numerous extra-digestive diseases known to be associated with OP/OF. The studies regarding relationship between H.p. infection (HPI) and OP/OFs are inconsistent. The current review summarizes the relevant literature on the potential role of HPI in OP, falls and OFs and highlights the reasons for controversies in the publications. In the first section, after a brief overview of HPI biological features, we analyze the studies evaluating the association of HPI and bone status. The second part includes data on the prevalence of OP/OFs in HPI-induced gastroduodenal diseases (peptic ulcer, chronic/atrophic gastritis and cancer) and the effects of acid-suppressive drugs. In the next section, we discuss the possible contribution of HPI-associated extra-digestive diseases and medications to OP/OF, focusing on conditions affecting both bone homeostasis and predisposing to falls. In the last section, we describe clinical implications of accumulated data on HPI as a co-factor of OP/OF and present a feasible five-step algorithm for OP/OF risk assessment and management in regard to HPI, emphasizing the importance of an integrative (but differentiated) holistic approach. Increased awareness about the consequences of HPI linked to OP/OF can aid early detection and management. Further research on the HPI–OP/OF relationship is needed to close current knowledge gaps and improve clinical management of both OP/OF and HPI-related disorders.
Highlights
Both Helicobacter pylori (H.p.) infection (HPI) and osteoporotic fractures (OFs) constitute major challenges for public health systems globally due to huge clinical and economic burdens
H.p. infection (HPI)-Induced Upper Gut Diseases and Osteoporotic Fractures. Another important piece of information on the HPI–OP/OF relationship could be expected from data regarding HPI-associated chronic diseases, many of which as well as the medications used are known to have deleterious effects on bone metabolism and/or increase risk of falls contributing to OFs
Findings in patients with HPI-induced chronic/atrophic gastritis suggest that gastric corpus structural and functional changes and associated nutritional deficiencies may negatively affect bone metabolism, neuromuscular and a wide range of other functions predisposing to OP, falls and OFs
Summary
Both Helicobacter pylori (H.p.) infection (HPI) and osteoporotic fractures (OFs) constitute major challenges for public health systems globally due to huge clinical and economic burdens. Accumulating evidence suggests that in health and disease stomach and gut directly and indirectly via multiple neurohormonal pathways regulate the musculoskeletal and other systems by controlling appetite, food intake, absorption of nutrients and energy balance [1,2,3,4,5,6,7]. These physiological relationships (including the gut/stomach–bone axis) may be affected by HPI. In this narrative review based mainly on the literature from the last decade, we present basic information on HPI, summarize the key findings and existing evidence in the literature for and against the impact of HPI-induced and -associated diseases on skeleton, falls and OFs, highlight the possible causes for controversies, discuss the practical implications of the accumulating knowledge and introduce a practical algorithm for management OP/OF incorporating the new data on the potential role of HPI
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