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

Wongtrakul, W.; Charoenngam, N.; Ungprasert, P.

Affiliations

¹Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand

²Department of Internal Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand

³Department of Rheumatic and Immunologic Diseases, Cleveland Clinic, Cleveland, USA

Abstract and keywords

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.

Keywords: Epidemiology; Fractures; Irritable bowel syndrome; Meta-analysis; Osteoporosis

Links

DOI: 10.1007/s00198-020-05318-y

PubMed: 32008157

WoS: 000510364000001

History

Received: 2019-10-25

Accepted: 2020-01-23

Online: 2020-02-01

Cited Works (1)

Year	Entry
2014	Wright NC, Looker AC, Saag KG, Curtis JR, Delzell ES, Randall S, Dawson‐Hughes B. The recent prevalence of osteoporosis and low bone mass in the United States based on bone mineral density at the femoral neck or lumbar spine. J Bone Miner Res. November 2014;29(11):2520-2526.