Irritable Bowel Syndrome Is a Risk of Osteoporosis: A Population-Based Nationwide 1 Cohort Study

Abstract

Background: Previous cohort studies, have reported higher rates of osteoporosis associated with irritable bowel syndrome (IBS). We evaluated the IBS as a risk factor for osteoporosis and osteoporotic fractures in Korea after adequately adjusting for basic confounding factors. Methods: We performed a nationwide population-based retrospective cohort study between January 1, 2002, and December 31, 2010 using National Health Insurance data, including 3,714 newly-diagnosed IBS patients. We matched every IBS case with non-IBS case from the database at a 1:4 frequency ratio (14,856 non-IBS patients). The outcome parameter was newly diagnosed patients with osteoporosis and osteoporotic fractures, defined as per the International Classification of Diseases, 10th Revision (ICD-10) code, and included those assigned the relevant diagnostic codes for osteoporosis, those receiving osteoporosis medications, those with non-traumatic vertebral, hip, pelvic, femur, clavicle, humerus, wrist, and ankle fractures, and those undergoing operative procedures for hip fractures. Findings: We found 3,714 patients (included 2,169 males and 1,545 females) with newly diagnosed IBS, and the number of the final age- and sex-matched study population was 18,570. The median follow-up duration was 85.97 and 87.48 months for males and females, respectively. The incidence of osteoporosis was higher in the IBS cohort. The Cox proportional regression model revealed that the hazard ratio [HR] for osteoporosis in patients with IBS was 1.509 (95% confidence interval [CI], 1.055-2.159) and 1.476 (95% CI, 1.241-1.754) in males and females, respectively. Furthermore, HR for osteoporotic fractures in female patients with IBS was 1.427 (95% CI, 1.086-1.876). Interpretation: Among patients with IBS 1.9% males and 11.4% females developed osteoporosis during the 7-year study period. We found a higher incidence of osteoporosis in patients with IBS than in those without, indicating an association of IBS with osteoporosis. Funding: None. Declaration of Interest: All authors have completed the ICMJE uniform disclosure form and declare: no financial relationships with any organizations that might have an interest in the submitted work i 321 n the previous three years; no other relationships or activities that could appear to have influenced the submitted work. Ethical Approval: This study was approved to be an exemption study by the Research Ethics Board of the Pusan University Hospital (E-2014090, 25th July 2014) because it was dealt with anonymous patient health records presented by HIRA. Therefore, there was no personally identifiable variable in our data and there were no need informed consents of patients in the present study.