Association Between Helicobacter pylori and Osteoporosis: A Systematic Review and Meta-analysis

Introduction: Helicobacter pylori (H. pylori) has been demonstrated to play an important role in the pathogenesis of extra-digestive conditions. However, it is still not clear about the association between H. pylori infection and osteoporosis. To further investigate this possible association, we conducted a systematic review and meta-analysis of observational studies to demonstrate the risk of osteoporosis in patients with H. pylori infection versus non-H. pylori infection. Methods: The Cochrane Central Register of Controlled Trials, Cochrane Library, Medline, and Embase were searched from database inception to December 2014 for all observational studies evaluating the association between H. pylori infection and bone mass, BMD, or osteoporosis. All patients were ≥18 years of age and had no other cause of osteoporosis, or pathological bone disease at baseline. Risk factor was H. pylori infection; control subjects were individuals without H. pylori infection. Results: Twenty articles underwent full-length review. Data were extracted from 4 cross-sectional studies involving 520 participants that reported number of participants with osteoporosis or odds ratio. We performed a meta-analysis using random-effects model and calculated pooled odds ratio (OR). The main meta-analysis showed no significant association between H. pylori infection and osteoporosis with OR =1.69 (95% CI: 0.78-3.69, p=0.18). The between-study heterogeneity was 68%. Conclusion: Controversy exists regarding the association H. pylori infection and osteoporosis probably because of too few studies included. Further prospective studies are needed to fully assess this relationship.Figure 1