Is there an association between peptic ulcer disease and osteoporosis: a systematic review and cumulative analysis

Eur J Gastroenterol Hepatol. 2021 Jan;33(1):9-16. doi: 10.1097/MEG.0000000000001981.


Background: Mounting studies have emerged indicating that patients with peptic ulcer disease (PUD) are at a high risk of developing osteoporosis, but the evidence has not been previously synthesized. The present study aims to examine whether patients with PUD have a significantly higher prevalence of osteoporosis than the healthy normal subjects.

Methods: Four electronic databases were systematically searched for eligible studies up to February 2020. The association between PUD and osteoporosis was evaluated by calculating the relative risk (RR) with a 95% confidence interval (CI).

Results: Six observational studies were finally included, enrolling a total of 216 122 individuals. Synthetic results from the six included studies providing the number of cases for both sexes demonstrated that PUD was significantly associated with an increased risk of osteoporosis (95% CI, 1.37-1.89; P < 0.001). In line with this finding, the combined effect from the three studies independently reporting the male subjects also yielded to a positive relationship between PUD and osteoporosis (RR = 2.08; 95% CI,1.10-3.93; P = 0.023). However, when restricted to female participants, pooled results indicated that women patients with PUD would not suffer significantly more risk of osteoporosis than the general women population (RR = 1.36; 95% CI, 0.84-2.21, P = 0.212).

Conclusions: This is the first study for quantifying the positive association between PUD and the risk of osteoporosis by conducting a meta-analysis. In clinical practice, assessment of the bone mineral density and antiosteoporosis treatments are recommended for those potential patients with PUD.

Publication types

  • Meta-Analysis
  • Systematic Review

MeSH terms

  • Databases, Factual
  • Female
  • Humans
  • Male
  • Osteoporosis* / epidemiology
  • Peptic Ulcer* / epidemiology
  • Prevalence