Journal of Gastroenterology and Hepatology · Mar 8, 2026

Effects of Successful Versus Delayed/Failed Helicobacter pylori Eradication Therapy on Subsequent Fracture Risk: a Population-Based Cohort Study

By Tan JT, Mao X, Cheung CL et al.

BACKGROUND: We determined the outcomes of Helicobacter pylori (HP) eradication on fracture risk. METHODS: This was a retrospective cohort study of patients who had received clarithromycin-based triple therapy for HP infection or undergone upper endoscopy with no HP infection found (HP negative) between 2003 and 2012 in Hong Kong. Patients were divided into three groups: (i) HP-negative, (ii) successful HP eradication, and (iii) delayed/failed HP eradication, and were observed till fracture development, death, or end of study. Propensity score (PS) adjustment was performed to account for ≥ 20 covariates (age, sex, comorbidities, and time-varying medication use). Following the establishment of PS-matched cohorts, the hazard ratio (HR) of fracture with HP eradication outcome was calculated by a multivariable Cox model. RESULTS: Of 322 180 eligible patients, 250 978 (77.9%) were HP-negative, 61 892 (19.2%) had successful HP eradication, and 9310 (2.9%) delayed/failed eradication. During a median follow-up of 11.5 years (IQR: 8.8-14.2), 16 935 (5.3%) developed fracture (vertebra: 1825; hip: 8338; humerus: 2147; forearm: 4080; carpal/wrist: 545). Compared with the HP-negative group, the successful HP eradication group did not have a higher fracture risk (HR: 1.02; 95% CI: 0.89-1.16). However, a higher fracture risk was observed in the delayed/failed HP eradication group (HR: 1.37; 95% CI: 1.21-1.56). Among delayed/failed HP eradication patients with and without prior history of gastric ulcer, the HR was 2.21 (95% CI: 1.10-4.45) and 1.35 (95% CI: 1.19-1.54), respectively. CONCLUSION: When compared with HP-negative individuals, only HP-positive patients with delayed/failed HP eradication had a higher fracture risk, particularly in those with a prior history of gastric ulcer. These results may suggest a potential protective association of successful HP eradication and subsequent fracture risk.

doi.org/10.1111/jgh.70310 Open access PubMed 41796978 Populations