Can atrophic gastritis contribute to osteoporosis?
Perspectives

Is there a link between atrophic gastritis and osteoporosis?

There is mounting evidence demonstrating that atrophic gastritis is likely to be a contributory factor leading to osteoporosis because it causes low stomach acidity, which itself hinders calcium absorption and bone mineralisation. The rapid detection and treatment of atrophic gastritis could therefore play a significant role in preventing the development of osteoporosis in certain higher risk individuals. In this blog, Graham Johnson, Managing Director at BIOHIT HealthCare Ltd., explores the possible connection between the two disorders, and discusses how GastroPanel® could support healthcare providers in quickly identifying at-risk patients in need of endoscopy and early intervention.

 

Investigating the relationship between gut and bone health

Osteoporosis is a metabolic bone disease characterised by a decrease in bone mass, which results in enhanced skeletal fragility and increased fracture risk.1 Post-menopausal women are the most at risk of developing osteoporosis, as the decrease in oestrogen production during menopause causes bone mineral density to decline faster than in other population groups.2 Osteoporosis causes over 8.9 million fractures worldwide annually, constituting a substantial economic burden to society and healthcare systems everywhere.1,2

The condition has several known gastroenterological risk factors, such as inflammatory bowel disease and coeliac disease, but there is growing evidence that indicates a possible causal relationship between the ability of the stomach to produce acid and the onset of osteoporosis in older adults. This is because the bioavailability of multiple dietary minerals, including iron and calcium, depends primarily on dissolution and ionisation by gastric acid.1,3 More specifically, low stomach acid production (hypochlorhydria) or the complete absence of stomach acid (achlorhydria) hinder the absorption of calcium from food, impairing bone mineralisation and potentially contributing to osteoporosis in later life.1–3 Detecting and addressing conditions that lower stomach acid production could therefore contribute to the prevention and treatment of osteoporosis in some individuals.

 

Establishing the underlying cause of low stomach acidity

Inadequate stomach acid production has numerous potential causes, including proton pump inhibitor (PPI) treatment, gastrectomy and atrophic gastritis.2,3 Atrophic gastritis is a chronic inflammatory condition of the gastric mucosa, and can itself be caused by a variety of conditions, including infection with the bacterium Helicobacter pylori (H. pylori),4 autoimmune disease and lifestyle factors.5 Recent studies suggest that if an individual has atrophic gastritis, they may have a higher likelihood of developing osteoporosis in the future.2 Likewise, if an individual has already been diagnosed with osteoporosis, research shows that atrophic gastritis is frequently also present and is likely to be a contributory factor.3 The timely identification of atrophic gastritis could therefore be vital in treating osteoporosis, and in helping to prevent its development in the first place, particularly in higher risk individuals including post-menopausal women or those on PPIs.2

 

An alternative diagnostic solution for atrophic gastritis

It is absolutely crucial to identify the root cause of achlorhydria in order to inform the most effective treatment pathway, whether that be eradication of H. pylori, lifestyle and dietary changes, adjustments to medication, or supplementation with hydrochloric acid. In the case of atrophic gastritis, diagnosis currently relies heavily on the analysis of gastric mucosal biopsies taken during a costly and invasive gastroscopy procedure, meaning that individuals may remain undiagnosed for a long period of time if they don’t meet the requirements for referral. The number of patients being referred for endoscopy is already placing a huge strain on stretched healthcare resources, and, coupled with non-specific symptoms, this means that the detection and management of atrophic gastritis often come very late. This delays the onset of treatment and hinders the initiation of preventative or remedial therapy for osteoporosis in at-risk groups.

 

GastroPanel® ‒ the multi-functional blood test

An approach that could help to speed up this process takes advantage of GastroPanel® from BIOHIT HealthCare, a first-line blood test for atrophic gastritis that detects H. pylori and the three biomarkers pepsinogen I, pepsinogen II and gastrin-17. The test can be used in primary care before referring for endoscopy to help identify patients with chronic atrophic gastritis in need of early intervention. It has the potential to enable some individuals to avoid uncomfortable and inconvenient invasive gastrointestinal diagnostic procedures, and also provides results far faster than biopsy analysis, helping clinicians to rule out the presence of atrophic gastritis as soon as possible. For individuals presenting with clinical signs of osteoporosis, non-invasive testing with GastroPanel® at the point of care could provide a fast and economic option to investigate the possible cause, without incurring additional strain on endoscopy services.

 

Supporting healthcare with fast and accurate diagnostics

Using GastroPanel® to quickly diagnose or exclude atrophic gastritis in patients at higher risk of developing osteoporosis would help to more efficiently prioritise those in need of endoscopies and further tests. As well as improving the patient experience, this could reduce the total number of endoscopies performed in lower risk individuals, helping to lighten the financial and time burdens on healthcare systems. These benefits underscore the value of GastroPanel® as a fast rule-out test for atrophic gastritis in primary care, and highlight its possible role as a tool for helping to prevent the onset of osteoporosis caused or aggravated by low stomach acidity.

 

Click here to find out more about GastroPanel®

 

References

  1. Kim HW, Kim YH, Han K, et al. Atrophic Gastritis: A Related Factor for Osteoporosis in Elderly Women. PLoS One. 2014;9(7):e101852. doi:10.1371/journal.pone.0101852
  2. Lee S, Yun JM, Park JH, Kwon H. Association between Chronic Atrophic Gastritis and Bone Mineral Density among Women Older than 40 Years of Age in Korea. Korean J Fam Med. Published online February 15, 2024. doi:10.4082/kjfm.22.0139
  3. Cavalcoli F, Zilli A, Conte D, Massironi S. Micronutrient deficiencies in patients with chronic atrophic autoimmune gastritis: A review. World J Gastroenterol. 2017;23(4):563. doi:10.3748/wjg.v23.i4.563
  4. Fisher L, Fisher A, Smith PN. Helicobacter pylori Related Diseases and Osteoporotic Fractures (Narrative Review). J Clin Med. 2020;9(10):3253. doi:10.3390/jcm9103253
  5. Cleveland Clinic. Hypochlorhydria. https://my.clevelandclinic.org/health/diseases/23392-hypochlorhydria.