Risk of Osteoporotic Fractures Higher in IBS Patients

Irritable bowel syndrome (IBS) may place individuals at increased risk for osteoporosis and osteoporosis-related fractures, new research indicates.

A recent study, published in Osteoporosis International and conducted by investigators at NorthShore University Health System, used the Nationwide Emergency Department Sample (NEDS) to review the records of 317,857 emergency department visits for patients with secondary IBS diagnoses, and compared them with the data collected from visits by persons without IBS during the same time period. Within the assessed group, 17,752 patients were diagnosed with osteoporosis, with a concurrent fracture diagnosis in 2197 cases.

They found that the risk for osteoporosis was higher among patients who had IBS than for those who did not (adjusted odds ratio [OR], 4.28; 95% confidence interval [CI], 4.21-4.35), as was the risk for osteoporotic fractures (OR, 2.36; CI, 2.26-2.47). The highest adjusted odds of fracture, compared with controls, was seen at the wrist site (OR, 2.41; CI, 2.10–2.77).¹

“Our study identifies IBS as a significant risk factor for osteoporosis and for bone fracture. Those patients should be screened for the development of osteoporosis, and should be advised about their increased risk of osteoporosis and bone fracture,” Eli Ehrenpreis, one of the authors of the report, said in a recent press release on the National Osteoporosis Society’s website.

This connection has been studied abroad, with similar results. A recent study conducted in Taiwan found a higher incidence of osteoporosis among patients with IBS than those without (6.90 vs 4.15 per 1000 person-years; hazard ratio [HR], 1.65-955; CI, 1.54-1.77). In their study, female patients aged 40 to 59 years who had IBS had the highest risk of developing osteoporosis, compared with women the same age who did not have IBS (HR, 4.42; 95% CI, 3.37-5.79 vs HR, 4.41; 95% CI, 3.67-5.29, respectively). In addition, in IBS patients younger than age 40 years, women had more than 2-fold greater risk of developing osteoporosis compared with males (HR, 2.18; 95% CI, 1.09-4.38).²

Similar research by Abraham et al found that in adults with inflammatory bowel disease, low vitamin D, male gender, Asian ethnicity, Crohn’s Disease, and corticosteroid use significantly increased the risk of having low bone mineral density.³

It has been estimated that 1 in 5 people suffer from IBS, and approximately 30% to 60% of individuals with IBS also have osteoporosis. While the connection is unclear, researchers currently exploring this association have speculated that one or several associating factors may be at work, including serotonin levels, immune system factors, lower-dairy diets common among persons with IBS, the prevalence of females with IBS (and the known increased risks of bone mineral density loss among this population), or the disease activity of IBS itself. More research needs to be done to further elucidate the correlation between IBS and osteoporosis, but at present, the authors recommend that patients with IBS be screened for osteoporosis in order to facilitate early detection and prevention of fractures. -Leah Jiorle

References

1. Stobaugh DJ, Deepak P, Ehrenpreis ED. Increased risk of osteoporosis-related fractures seen in patients with irritable bowel syndrome. Osteoporosis Int. 2013;24(4):1169-1175.
2. Yen CM, Muo, CH, Lin MC, Chang SN, Chang YJ, Kao CH. A nationwide population cohort study: irritable bowel syndrome is a risk factor for osteoporosis. Eur J Intern Med. 2014;25(1):87-91.
3. Abraham BP, Prasad P, Malaty HM. Vitamin D deficiency and corticosteroid use are risk factors for low bone mineral density in inflammatory bowel disease patients. Dig Dis Sci. Published online ahead of print March 12, 2014.