The cause-effect relationship between iron deficiency anemia (IDA) and osteoporosis has not been established in the general population. Thus, the current longitudinal study determined the role of IDA as a risk factor for osteoporosis by analyzing a large nationwide population-based sample. In a sample of 1,000,000 randomly sampled individuals from the 1998-2012. Taiwan National Health Insurance Research Database, patients with IDA (case group (n = 35,751)) and individuals without IDA (control group (n = 178,755)) were compared. Patients who were <20 years of age and who had pre-existing osteoporosis prior to the diagnosis of IDA were excluded. Each patient with IDA was age- and gender-matched to five individuals without IDA. The diagnoses of IDA and osteoporosis (coded using ICD-9CM) were further confirmed with blood test results and X-ray bone densitometry to ensure the accuracy of the diagnoses. Osteoporosis occurred more often among patients with IDA compared to individuals without IDA (2.27% vs. 1.32%, p < 0.001). Cox proportional hazard analysis revealed that the risk for osteoporosis was significantly higher in the case than the control group (hazard ratio (HR) = 1.74; 95% CI = 1.61-1.88) and remained similar after adjustment for covariates (adjusted HR = 1.81; 95% CI = 1.67-1.97). Compared with individuals without IDA, the risk for osteoporosis was even higher for patients with IDA who received intravenous ferrum therapy (adjusted HR = 2.21; 95% CI = 1.85-2.63). In contrast, the risk for osteoporosis was reduced for patients with IDA who received a blood transfusion (adjusted HR = 1.47; 95% CI = 1.20-1.80). As a predictor, prior IDA is a significant and independent risk factor for development of osteoporosis.

译文

:铁缺乏性贫血(IDA)和骨质疏松症之间的因果关系尚未建立。因此,当前的纵向研究通过分析全国范围内大量的基于人群的样本,确定了IDA作为骨质疏松症危险因素的作用。在1998年至2012年的1,000,000个随机样本中进行抽样。台湾国家健康保险研究数据库比较了IDA患者(病例组(n = 35,751))和无IDA患者(对照组(n = 178,755))。年龄小于20岁且在IDA诊断之前已存在骨质疏松症的患者被排除在外。每名IDA患者的年龄和性别均与5名没有IDA的患者相匹配。通过血液测试结果和X射线骨密度测定法进一步证实了IDA和骨质疏松的诊断(使用ICD-9CM编码),以确保诊断的准确性。与没有IDA的患者相比,IDA患者的骨质疏松症发生率更高(2.27%对1.32%,p <0.001)。 Cox比例风险分析表明,骨质疏松的风险明显高于对照组(风险比(HR)= 1.74; 95%CI = 1.61-1.88),并且在调整协变量后(调整后HR = 1.81; 95%CI = 1.67-1.97)。与没有IDA的个体相比,接受静脉铁素治疗的IDA患骨质疏松症的风险更高(校正后的HR = 2.21; 95%CI = 1.85-2.63)。相比之下,接受输血的IDA患者的骨质疏松症风险降低了(调整后的HR = 1.47; 95%CI = 1.20-1.80)。作为预测因素,先前的IDA是骨质疏松症发展的重要且独立的危险因素。

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