Clinical—Alimentary TractHip Fracture Risk in Patients With a Diagnosis of Pernicious Anemia
Section snippets
Study Design
We conducted a retrospective cohort study utilizing the General Practice Research Database (GPRD). The protocol for this study was approved by the University of Pennsylvania Institutional Review Board and the GPRD Independent Scientific Advisory Committee.
Data Source
The GPRD is a computerized medical record database system for general practitioners in the United Kingdom that was first established in May 1987.23 The database contains prospective information from >700 general practices in the United
Results
We identified 9544 patients with a diagnosis of PA who had received vitamin B-12 therapy for at least 1 year within GPRD. All but 38 (0.4%) of the 9544 patients with a diagnosis of PA were each matched with 4 sex- and age-comparable non-PA patients (n = 38,024). The 38 PA patients for whom no matched controls could be found were excluded from further analysis (Figure 1). The mean follow-up time was comparable among the controls compared to the patients with a diagnosis of PA (5.31 vs 5.17
Discussion
Patients with a diagnosis of PA have an increased risk of hip fracture compared to a control group from the same general UK population within the GPRD even after accounting for potential confounders. This risk increase was even more pronounced when the analysis was restricted to those patients newly diagnosed with PA after 1 year of GPRD follow-up. In addition, the increased risk of hip fracture among patients with a diagnosis of PA persisted after B-12 repletion.
There has been only 1 previous
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2022, Seminars in Cell and Developmental BiologyCitation Excerpt :In humans, achlorhydria also stimulates gastrin release and impairs calcium absorption [116]. Lower BMD and higher fracture risk are reported in patients with achlorhydria due to atrophic gastritis [117] or PPI treatment [118]. Importantly, osteopenia occurs following both gastrectomy and fundectomy even though the former causes hypergastrinemia and the latter hypergastrinemia [119].
Shaping the bone through iron and iron-related proteins
2021, Seminars in HematologyCitation Excerpt :Several cohort studies have linked low hemoglobin levels to low bone mineral density [18-20]. Three large studies showed that the risk for sustaining a hip fracture is 2-3-fold higher in anemic subjects compared to controls [21-24]. Importantly, also iron overload has been associated with poor bone quality in patients with HH and secondary hemochromatosis.
Megaloblastic Anemias
2018, Hematology: Basic Principles and PracticeComplications of Proton Pump Inhibitor Therapy
2017, GastroenterologyCitation Excerpt :Any association between pernicious anemia (PA) and these various adverse effects could provide us with an idea of the upper bound of any PPI effect; PA is associated with achlorhydria, which does not occur with even high-dose PPI therapy. Among patients with PA, there appear to be moderately increased risks of hip fracture75 and CAP,76 but no increased risk of colorectal77 or pancreatic cancer.78 As noted, intragastric pH is higher among patients with PA than among patients on PPI therapy79 and is sustained for much longer.
Conflicts of interest The authors disclose the following: Dr Metz reports serving as a consultant and receiving honoraria and/or grant support from AstraZeneca, TAP Pharmaceutical Products, Altana, Wyeth-Ayerst Laboratories, Santarus, and Eisai. Dr Yang reports having served as a consultant for AstraZeneca and received grant support from AstraZeneca and GlaxoSmithKline. The remaining auhors disclose no conflicts.
Funding Dr Merriman was supported by a National Institutes of Health educational training grant during his gastroenterology and epidemiologic training at the University of Pennsylvania. Dr Yang was supported by a National Institutes of Health/National Institute of Diabetes and Digestive and Kidney Diseases Mentored Career Development Award (K08 DK062978), which also funded the access to the data in the General Practice Research Database. This study was supported by an academic development fund from the University of Pennsylvania to Dr Yang. The funding sponsors played no role in the study design in the collection, analysis, and interpretation of data.