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Nutrients 2017, 9(6), 616;

Iron Deficiency Anemia as a Risk Factor for Osteoporosis in Taiwan: A Nationwide Population-Based Study

Institute of Information Science, Academia Sinica, Taipei 115, Taiwan
Department of Physical Medicine and Rehabilitation, Mackay Memorial Hospital, Taipei 104, Taiwan
Department of Mechanical Engineering, National Chiao-Tung University, Hsinchu 300, Taiwan
Department of Obstetrics and Gynecology, Taipei Tzu-Chi Hospital, The Buddhist Tzu-Chi Medical Foundation, Taipei 231, Taiwan
School of Medicine, Tzu-Chi University, Hualien 970, Taiwan
Author to whom correspondence should be addressed.
Received: 9 April 2017 / Revised: 28 May 2017 / Accepted: 13 June 2017 / Published: 16 June 2017
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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. View Full-Text
Keywords: iron deficiency anemia; osteoporosis; ferrum infusion; blood transfusion iron deficiency anemia; osteoporosis; ferrum infusion; blood transfusion

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Pan, M.-L.; Chen, L.-R.; Tsao, H.-M.; Chen, K.-H. Iron Deficiency Anemia as a Risk Factor for Osteoporosis in Taiwan: A Nationwide Population-Based Study. Nutrients 2017, 9, 616.

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