Increased Risk of Osteoporosis Related Fractures in Patients with Irritable Bowel Syndrome: Presidential Poster

Abstract

Purpose: Altered serotonin levels may play a role in the pathogenesis of irritable bowel syndrome (IBS). Mutations in the LDL-receptor related protein five with resultant elevated blood serotonin levels has been shown to result in osteoporosis in murine model. Patients with diarrhea predominant IBS (IBS-D) have been shown to have elevated circulating cytokines that have been associated with metabolic bone disease in inflammatory bowel disease. We hypothesized that IBS patients may have an increased risk of osteoporosis and related fractures. Methods: The 2008 Nationwide Emergency Department Sample (NEDS) database, contains approximately 28.4 million discharges across 950 hospitals in 28 states, which is a 20% sampling frame of all ED discharges across the United States. NEDS was used to determine the risk 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 fracture 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 secondary diagnosis of IBS (utilizing data weights). Of these, 17,752 carried a diagnosis of osteoporosis. Concurrent diagnosis of a pathological or traumatic fracture of the wrist, hip or vertebra was seen in 2,197 patients. Overall, patients with IBS had an increased risk of osteoporosis (Odds Ratio (OR) 4.28; 95% Confidence Interval (CI) 4.21-4.35); present across all age groups (Table 1). IBS patients also had an increased risk of osteoporotic fractures (OR 2.36; CI 2.26-2.47) compared to the non-IBS control group, with the highest risk seen for wrist fractures (Table 2).Table: Age stratified risk of osteoporosis in patients with irritable bowel syndromeTable: [1730] Differences in the risk of all fractures in patients with IBS by anatomical regionConclusion: A history of IBS appears to be associated with an increased risk of osteoporosis and related fractures. Further research is necessary to establish definite mechanisms.