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

Gyu Lee Kim,Youn Hye Cho,Yu Hyeon Yi,Hye Rim Hwang,Jeong Gyu Lee,Young Jin Tak,Eun Ju Park,Seung Hun Lee,Jinmi Kim,Sang Yeoup Lee,Yun Jin Kim,Youngmin Park,Youngin Lee

doi:10.3390/jcm10092044

Abstract

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.

Highlights

Recent studies have suggested that irritable bowel syndrome (IBS) could be a risk factor for osteoporosis, the pathogenesis is still unknown
This study is the first study to find that the use of IBS medication is associated with osteoporosis and osteoporotic fractures, using Observational Medical Outcomes Partnership (OMOP) Common Data Model (CDM) data
This is the first study to reveal that osteoporosis and osteoporotic fractures were significantly increased in the patients taking IBS treatment medications; even in those not diagnosed with IBS but receiving IBS treatment, there was a significant increase in osteoporosis (HR 1.77) and fractures (HR 1.69)

Summary

Introduction

Recent studies have suggested that irritable bowel syndrome (IBS) could be a risk factor for osteoporosis, the pathogenesis is still unknown. A meta-analysis of 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 [1]. Hyperactivity of the hypothalamic pituitary adrenal gland, and nutritional deficiencies have all been implicated in a high risk of developing osteoporosis [2]. Chronic inflammatory conditions in IBS patients are known to increase intestinal irritability due to mucosal inflammation and have an additional effect on gastrointestinal absorption [3]. Osteoporosis is considered to be a multifactorial systemic disease [4]. It is known that chronic inflammatory pathophysiology that affects gastrointestinal absorption is commonly associated with osteoporosis [5]

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