Osteoporosis Is Associated with an Increased Risk of Colorectal Adenoma and High-Risk Adenoma: A Retrospective, Multicenter, Cross-Sectional, Case-Control Study

Abstract

Background/Aims: The protective effects of vitamin D and calcium on colorectal neoplasms are known. Bone mineral density (BMD) may be a reliable biomarker that reflects the long-term anticancer effect of vitamin D and calcium. This study aimed to evaluate the association between BMD and colorectal adenomas including high-risk adenoma.Methods: A multicenter, cross-sectional, case-control study was conducted among participants with average risk of colorectal cancer who underwent BMD and screening colonoscopy between 2015 and 2019. The main outcome was the detection of colorectal neoplasms. The variable under consideration was low BMD (osteopenia/osteoporosis). The logistic regression model included baseline demographics, components of metabolic syndrome, fatty liver disease status, and aspirin and multivitamin use.Results: A total of 2,109 subjects were enrolled. The mean age was 52.1±10.8 years and 42.6% were male. The adenoma detection rate was 43%. Colorectal adenoma and high-risk adenoma were both more prevalent in subjects with low BMD than those with normal BMD (48.2% vs 38.8% and 12.1% vs 9.1%). In the univariate analysis, old age, male sex, smoking, metabolic components, fatty liver, and osteoporosis were significantly associated with the risk of adenoma and high-risk adenoma. In the multivariate analysis, osteoporosis was independently associated with risk of colorectal adenoma (odds ratio [OR], 1.65; 95% confidence interval [CI], 1.11 to 2.46; p=0.014) and high-risk adenoma (OR, 1.94; 95% CI, 1.14 to 3.29; p=0.014). Conclusions:Osteoporosis is an independent risk factor of colorectal adenoma and high-risk adenoma.

Osteoporosis Is Associated with an Increased Risk of Colorectal Neoplasms Regardless of Sex: Nationwide Population-Based Cohort Study

“…A multicenter study in Korea confirmed that osteoporosis is an independent risk factor for colorectal and high-risk adenomas. However, in the subgroup analysis according to sex, osteoporosis increased the risk of adenoma only in women (OR = 1.66, p = 0.034 vs. OR = 1.45, p = 0.417), which is believed to be due to the limited sample size [ 12 ]. Our study targeted a larger sample size and found that osteoporosis increased the risk of CRN regardless of sex, although the OR for this risk was higher in women than in men (OR = 2.06 vs. OR = 1.66, both p < 0.0001).…”

“…Epidemiologic studies have suggested that lower BMD is associated with an increased risk for colorectal adenoma/cancer, especially in postmenopausal women [ 9 , 11 , 12 ]. The biological mechanisms linking bone mass to the risk of CRC are not fully understood; however, cumulative exposure to estrogen may play a role, and so may vitamin D deficiency.…”

“…However, most studies on the association between osteoporosis and the risk of CRN have been limited to elderly women or are single-center or multicenter cross-sectional studies that target patients at individual medical institutions [ 11 , 12 ]. In this study, we investigated the association between osteoporosis and CRN using claims data from the National Health Insurance Service (NHIS), which represents the entire population.…”

Occult Vertebral Fracture (OVF) in Patients Who Underwent Hepatectomy for Colorectal Liver Metastasis: Strong Association with Oncological Outcomes

“…Oxaliplatin induces kidney failure caused by proximal tubule injury, resulting in hypomagnesaemia, which aggravates bone loss by preventing vitamin D synthesis [24]. In addition, vitamin D has been reported to suppress the growth of malignancies including colorectal cancer [25,26]. Vitamin D deficiency, which reduces BMD, may be one of the causes of poor prognosis in patients with OVF.…”