Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Department of Internal Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Osteoporos Int. 2020 Jun;31(6):1049-1057. doi: 10.1007/s00198-020-05318-y. Epub 2020 Feb 1.
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.
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.
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; I 100%). Sensitivity analysis including only cohort studies found a lower RR (pooled RR 1.55; 95% CI, 1.39-1.72) with a lower I (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; I 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 I (0%). Limitations included high heterogeneity and reliance on diagnostic codes.
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.
最近的研究表明，肠易激综合征（IBS）可能是骨质疏松症的一个风险因素，尽管证据仍然有限。本研究旨在通过系统综述和荟萃分析技术全面评估 IBS 患者发生骨质疏松症的风险。
两位研究人员独立使用 MEDLINE、EMBASE 和 Google Scholar 数据库进行文献检索，检索时间截至 2019 年 10 月。合格的研究必须评估 IBS 患者是否有更高的骨质疏松症和/或骨质疏松性骨折风险。可以是横断面研究、病例对照研究或队列研究。从每项合格研究中提取点估计值和标准误，然后使用 DerSimonian 和 Laird 的通用倒数方差法进行合并。
从三个数据库中识别出的 320 篇文章中，有 4 项队列研究和 1 项横断面研究共 526633 名参与者符合纳入标准并纳入荟萃分析。五项研究均探讨了 IBS 患者发生骨质疏松症的风险，汇总分析发现，IBS 患者发生骨质疏松症的风险明显高于无 IBS 患者，汇总风险比为 1.95（95%CI，1.04-3.64；I 2 =100%）。敏感性分析仅包括队列研究，RR 较低（汇总 RR 1.55；95%CI，1.39-1.72；I 2 =59%）。三项研究探讨了骨质疏松性骨折的风险，汇总分析发现，IBS 患者发生骨质疏松性骨折的风险也高于无 IBS 患者，汇总风险比为 1.58，但未达到统计学意义（95%CI，0.95-2.62；I 2 =99%）。敏感性分析仅包括队列研究，RR 较低（汇总 RR 1.27；95%CI，1.20-1.39；I 2 =0%）。局限性包括高度异质性和对诊断代码的依赖。
本研究观察到 IBS 患者骨质疏松症的风险显著增加。对于这些患者，早期干预以预防骨质疏松症的发生，如负重锻炼、充足摄入维生素 D 和钙、早期筛查骨质疏松症，可能是有益的，尽管仍需要进一步的研究来证实这种方法的疗效和成本效益。
